ORIGINAL SIGNED BY SIGNATORY [ill STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CDSS ......--- 101 GOLF COURSE DR. STE. A-230 DEPARTMENT OF SOCIAL SERVICES ROHNERT PARK, CA 94928 JOHN A . WAGNER DIRECTOR ARNOLD SCHWARZENEGGER GOVERNOR January 29, 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A, CA 94558 Dear Mr. Welch: SUBJECT: California Public Records Act Request Per your recent Publics Records Act Request, attached is a list of the facilities that have received Type A violations and/ or civil penalties from the Rohnert Park office in 2009. In addition , the following information you requested can be obtained regarding the names of directors or licensees, and the addresses and telephone numbers on our website at www.ccld.ca.gov. Once on the website click on "Find Licensed Care" . In this screen the information requested can be retrieved. Sincerely, Linda Walker Licensing Program Manager C: Linda Kyrla, Regional Manager Darryl East, Assist. Chief Counsel ORIGINAL SIGNED BY SIGNATORY California Public Records Act Request Letter (FAS) - (11 /08) ORIGINAL SIGNED BY SIGNATORY [ill STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CDSS 101 GOLF COURSE DR. STE . A-230 JOHN A. WAGNER DIRECTOR ROHN ERT PARK, CA 94928 DEPARTMENT OF SOCIAL SERVICES ---- ARNOLDSCHWARZENEGGER GOVERNOR December 23, 2009 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A CA 94558 Dear Mr. Welch: SUBJECT: California Public Records Act Request The California Department of Social Services (CDSS) Chico Regional Office, Rohnert Park Local Unit Office is responding to your California Public Records Act (CPRA) request dated December 14, 2009. CDSS will promptly initiate an inquiry into the existence and feasibility of gathering disclosable public records responsive to your request. When the records responsive to your request are identified, you will be notified . Due to severe budgetary and staffing constraints, the Rohnert Park office is unable to actually copy the documents for you . You may of course retain a private copying service. If you do so, please have that service make an appointment to copy the public records . If you have any questions or require further assistance in this matter, please contact me at (707) 588-5034. Sincerely, Linda Walker Licensing Program Manager c: Linda Kryla, Regional Manager Francine Kammeyer, Senior Staff Counsel ORIGINAL SIGNED BY SIGNATORY CPRA Letter (FAS) • (11/08) ORIGINAL SIGNED BY SIGNATORY [ill CDSS ,.----. STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 101 GOLF COURSE DR. STE. A-230 JOKN A . WAGNER DIRECTOR ROHNERT PARK, CA 94928 A RNOLDSCHWARZENEGGER GOVERNOR January 22, 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A, CA 94558 Dear Mr. Welch: I am in receipt of your appeal received in our office December 24, 2009 requested to dismiss the citations issued on 12/16/09. I have spoken to Ms. Keehn and reviewed the issues involving complaint # 01-CC-20090728151400 received in our office on 7/28/09 regarding personal rights; Section (1 012290(a)(1) and Section(1 01223(a)(2) ; lack of supervision issues at the Lincoln Ave facility. I have also read your appeal letter and letters submitted from two of your parents, thank you for including them . In your appeal letter you state that the citation you received on 12/16/09 was the same as one issued to you on 7/28/09. A review of our records doesn't show any citations issued to you on 7/28/09. Ms. Keehn did visit your facil ity on 8/5/09 and during that visit she gave you a LIC 9099 opening the complaint stating further investigation would be needed and gave you a LIC 809 for a case management visit which included citations . Ms. Keehn conducted a complete and thorough investigation regarding the allegations involving the complaint and concluded that the facility failed to provide supervision necessary to meet a child's needs as a child had bitten others many times and that more than one child had been bitten. The allegation was substantiated and an appropriate citation was issued to you in the report dated 12/16/09. This was not a duplicate citation . It is true that you closed your facility at Lincoln Ave in October, however, since the complaint came in prior to the closure it was appropriate fo r Ms. Keehn to conclude the complaint that was received in our office prior to you closing the facility. In regards to dismissing H&S Section 1596.8595 relating the AB 633. Interviews with parents stated that they did not receive copies of some of the reports as well as the non compliance conference documents. In addition , this is a repeat violation that has occurred within the year. Based on this the citation is upheld. Sincerely, Linda Walker Licensing Program Manager ORIGINAL SIGNED BY SIGNATORY Appeal Loner Latter (FAS) - Children's Cottage Child Care, Inc. 1078 East Ave, Napa CA 94559 (707) 224-382 Serving Napa Families Since 1993 ChildrensCottage.com License #'s 283005477 & 283007874 December 21 , 2009 Supervisor Linda Walker Community Care Licensing 101 Golf Course Drive A-230 Rohnert Park, CA 94928 Dear Linda, Susan Keehn cited a Type A violation 10 1223a2 referencing a 12/16/2009 visit With a complaint control number 01-CC-20090728151400. We would like to appeal this citation. • • • • • • There was no visit by this LP A or any LP A on December 16, 2009 Facility number 283006845 was for a school at 780 Lincoln Ave in Napa The school at Lincoln Ave closed in Oct 2009 and was not open on 12/16/09 This is the exact same violation that was already cited on 7/28/09 The 7/28/09 has the same control #0 1-CC-20090728151400 as the "new" violation Parents Mekaila Guinn & Amanda Brewer have written letters to licensing calling this a "false complaint" and saying they were uncomfortable with LPA' s asking very personal questions. Please review these letters of support for Children' s Cottage Sincerely, Ray Welch DEPT. OF SOCIAL SERVICES ROHNERT P.A.~I( P.J?'r,!ONAL OFFICE DEC 2 4 2009 COMMUNITY CARE LICENSING Children's Cottage Child Care, Inc. 1078 East Ave, Napa CA 94559 (707) 224-382 Serving Napa Families Since 1993 ChildrensCottage.com License #'s 283005477 & 283007874 December 21, 2009 Susan Keehn Community Care Licensing 101 Golf Course Drive A-230 Rohnert Park, CA 94928 This is the child infant roster you had requested from our program. Thank you, Y asmin Solorio-Vallejo DEPT. OF SOCIAL SERVICES ROHNERT PARK PEG!ONAL OFFICE DEC 2 4 2009 COMMUNilY CARE liCENSING Children's Cottage Child Care, Inc. 1078 East Ave, Napa CA 94559 (707) 224-382 Serving Napa Families Since 1993 ChildrensCottage.com License #'s 283005477 & 283007874 December 21, 2009 Susan Keehn Community Care Licensing 101 Golf Course Drive A-230 Rohnert Park, CA 94928 Plan of correction Type A 101223 a2 Personal Rights Our plan of correction is we will have a staff shadow the child that is having a hard time biting and provide utilities to help the child. We also had a meeting with both parents informing them what our procedure is going to be when the child bites again. When the child bites again the parent will be called to come pick up the child from day care. If we tried to work with the child and don't see a progress and doesn't stop biting we will des-enroll the child. Thank you, Yasmin Solorio-Vallejo DEPT. OF SOCIAL SERVICES ROHNERT PARK I'FntONAL OFFICE DEC 2 4 2009 COMMUNITY CARE LICENSING Children's Cottage Child Care, Inc. 1078 East Ave, Napa CA 94559 (707) 224-382 Serving Napa Families Since 1993 ChildrensCottage.com License #'s 283005477 & 283007874 December 21 , 2009 Susan Keehn Community Care Licensing 101 Golf Course Drive A-230 Rohnert Park, CA 94928 Plan of correction Type A 101229 a1 responsibility for providing care and supervision. I believe that we already got cited for this same violation on the date 8/05/09 the control number is 01-CC-20090728151400 and the complaint was received in you' re office 7/28/09 which is the same complaint and control number you send us on December 16,2009. The only different things I found in the new citation were the times and the date it was send to Ray by mail, but the control number and the citation number and dates were exactly the same. The complaint was taking care of when we were at the Lincoln location I personally talked to Susan Keehn and came up with a plan of correction and she also interview my staff on what we did when a child was biting. So please explain to me why are we getting cited again and want another plan of correction if we already took care of this matter. For your information our plan of correction was; we had a staff member shadow the child that was having a hard time biting and re- direct her and give her teething rings and teething tablets so it would help her. We had a parent meeting with both parent to tell them what our plan was going to be if it was to happen again. I told them if the child bit again the parent will be called and the child will be picked up immediately. If the child continue to bite the child will be dis-enrolled. That would be our plan of correction and procedure we will do when this happens. Thank you, Yasmin Solorio-Vallejo DEPT. OF SOCIAL SERVICES ROHNERT DAQI< Pl=r.•nNAI ()FFICE DEC 2 4 2009 COMMUNITY CARE LICENSING Children's Cottage Child Care, Inc. 1078 East Ave, Napa CA 94559 (707) 224-382 Serving Napa Families Since 1993 ChildrensCottage.com License #'s 283005477 & 283007874 December 21, 2009 Susan Keehn Community Care Licensing 101 Golf Course Drive A-230 Rohnert Park, CA 94928 Plan of correction Type B h&S1596.8595(c) Parent Notification Our plan of correction will be still keep handing out the type A citations and non compliance conferences. It would help me understand if you would be more clear about this citation because as far as I know our files are up to date on everything and all the reports have been given to the parents. It would help me clarify my misunderstanding if you would send me a list of the parent that haven't received the paperwork, so I can take care of this matter promptly and hand out the paperwork necessary, to the parent that are stating that have not receive any paperwork. This will help us identify the plan of correction. Thank you, Yasmin Solorio-Vallejo DEPT. OF SOCIAL SERVICES ROHNERT P.61;)1( J)F:r.I()NAI f')F=F=If':F DEC 2 4 2009 COMMUNil Y CARE LICENSING ORIGINAL SIGNED BY SIGNATORY [ill STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CDSS 101 GOLF COURSE DR. STE. A-230 JOHN A . WAGNER DIRECTOR ROHNERT PARK, CA 94928 ---- DEPARTMENT OF SOCIAL SERVICES ARNOLD SCHWARZENEGGER GOVERNOR December 16, 2009 CH ILDREN'S COTTAGE CHILD CARE , INC. -INFANT283007874 1078 EAST AVENUE NAP A, CA 94559 Dear Mr. Welch: Enclosed are findings of two complaint investigations. If you would be kind enough to sign the reports and return a signed copy in the enclosed stamped envelope, it would be appreciated. Please provide a copy of the children's roster for the infant program. Thank you, Susan Keehn Licensing Program Analyst 588-5056 ORIGINAL SIGNED BY SIGNATORY req uesting sig ned copies & roster Letter (FAS) - (1 1/08) ORIGINAL SIGNED BY SIGNATORY D] STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CDSS 101 GOLF COURSE DR. STE. A-230 JOHNA. WAGNER DIRECTOR ROHNERT PARK, CA 94928 ---- DEPARTMENT OF SOCIAL SERVICES A RNOL OSCHWARZENEGGER GOVERNOR February 08 , 2010 CHILDREN'S COTIAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A, CA 94558 Dear Mr. Welch: 1 am responding to your appeal received in the office November 30, 2009 requesting to dismiss 7 citations issued November 17, 2009. The following citations will be discussed below: Sections 101229(a)(1) Responsibility for Providing Care and Supervision; 101238(g)(1 ); (a)(1) and (a) Buildings and Grounds; 101230(c) Napping ; and 101216.3(a)Teacher-Child Ratios. Section 101229(a)(1) Responsibility for Providing Care and Supervision: regarding the playhouse not being adequately supervised . I appreciate that the playhouse has been a part of your facility for a long period of time. I cannot speak to what others have observed in the past, however, on Nov. 17, 2009 when Terri Jensen made a visit to your facility she was informed by staff that they could only supervise the playhouse if they were standing right next to it. During Terri's visit children were actively playing in and around the playhouse and she didn't observe staff going over to check the playhouse area. The citation issued for inadequate supervision of the playhouse was appropriate and will remain as part of your record. Section 101229(a)(1) Responsibility for Providing Care and Supervision: citation issued as part of the complaint investigation involving inappropriate play with the toy refrigerators . Your argument suggests that sometimes children break the rules and that it is normal to learn through life experiences. This citation rests due to the following : children were playing with the refrigerators inappropriately and in an unsafe manner as well as staff admitted that they do not always watch the children playing with the refrigerators and they know it is a problem. Based on this admission by staff, the citation will be upheld. Your request to have the civil penalty dismissed is granted based on the dismissal of this same citation issued 9/22/09 cancels it becoming a repeat violation within a 12 month period . Section 101238(g)(1) Buildings and Grounds: The citation will be reduced to a "B" based on the compounds were not identified and not immediately accessible to the preschoolers. Section 101238(a)(1) Buildings and Grounds : Thank you for bringing this error in the citation not correctly being cited . I will have this citation amended to reflect the correct regulation number. LPA's come to facilities for a multitude of reasons and depending on the circumstances , STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE ~ P'IItN\A'DUAPt:ri4EN'T Of tOCW.. Sl.RVK:£$ FACILITY EVALUATION REPORT CC\.0 f\e0~~'.1!11, 0,0 \.1 CouRse DR. ST~ A-2)0 ROHNERT PARK,·CA.I412.8 , COMMU>IITV CARE UC~ 1liVISKlN PLAN OF COR~ECTlONS(POCs) DEFICIENCIES 1 RESPONSIBIUlY FOR PROVIDING CARE AND l Type A 1010612009 Section Cltod 101229a1 2 ·SUPERVISION No chlld(ren) shall be left without 3 the aupervlsloo of a teacher •1 any lime. except as 4 specified In Sections 101216.2(e)(1) and 5 101230(c)(1). Supei'Asion shall Include vlsu;ll 6 .obsGMIUon. On 9122109 LPA obse1'9ed a 7 child who was using tha resi!DOm and who 8. was loft alone. Licensee explained that the child .9, hed diatea end the teacher aUowed the child 10 pi!Yacy end was In another room geltirig·a chatlge :~~ bl clothing. As tho child had dlamea which Is an Indication ot being m. the child roqu~ed dose 13 supetV!slon. 14 1 I will read .the rfl!llll&tion. i·wlll write a brief 2 oummaJY of what lh&'iegUratiQn means and hoW It 3 wiD be implemented In the future, I will send this to 4 Licensing by 101612009. I will further lnl0j111 staff of 5 the regutaUon. • 3 8 9 10 11 12 13 14 4 4 5 6 7 5 6 7 1 2 1 2 3 3 4 5 4 5 6 7 6 7 --- - Failure to correct the cited deflclency(les), on or before the Plan of Correction (POC) due~ate, may rasult In a civil penalty assesament. SUPERVISOR'S NAME: Unda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR-NAME: Susan Keehn TELEPHONE; (707) 588-5056 J LICENSING EVALUATOR SIGNATURE: ~~ DATE: 10/0212009 I acknowledg,e rocelpt of this form ond underetand my appeal rights as explained and receivad. FACIUTY REPRESENTATIVE SIGNATURE: UCIH (FAS) • (0~) FACILITY EVALUATION REPORT COMMUMTY CARE UC:ENSING OMSIOH FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR: WELCH, MARY ADDRESS: 1078 EAST AVENUE STATE: CA NAPA CITY: CENSUS: 45 CAPACITY: 45 UNANNOUNCED TYPE OF VISIT: Annual/Required MET WITH : Ray Welch, Director 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 09122/2009 11:00AM .05:00PM NARRATIVE . LPA S. Keehn and LPM l. Walker visited for the purpose of conducting a comprehensive Random inspection' to check for compliance with Title 22 Regulations. Pres.e nt on arrival are 34 Preschool children with 4 staff. There were 11 toddlers with 2 staff. Director is Ray Welch who is present. This preschool has a toddler option. The roster is current and a copy given. The fire extinguisher was serviced in Oct. 2008 and is fully charged. Bathrooms appear dean. Toilets and faucets work. There is soap, paper towels and toilet paper to meet the needs of children. Water temperature at sinks used by children is per regulation. Changing table is within arm's reach of a sink. Staff states there are currently no children being potty trained. lunch is brought from home . The center provides snack. Medication is kept in a locked box and each child has a note and form from authorized representative. Cleaning supplies are stored separately from food and are inaccessible to children. Cots, mats and bedding are stored property. Drinking water is available by paper cups and the faucet. Posting requirements are met. The office and staff restroom is used for the isolation of an ill child. Sign in and sign out sheets are reviewed. No transportation is provided . The outdoor play area has shade provided by trees and two shade structures. There is adequate cushioning material beneath climbing structures. Drinking water is available by drinking fountain outdoors. Staff and children's.reconds are reviewed. Toddlers have a Needs and Services Plan on file but il ls there is no date, so it is unknown if they are updated as required. See 809 for deficiencies. Notice of Site Visit is posted and must remain posted for 30 days. SUPERVISOR'S NAME: Unda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: ~ DATE: 09/22/2009 I acknowledge receipt of this form and understand iny licensing appeal rights as explained and received. DATE: 10/02/2009 This Notice II)U&t be postad for 30 daya CAUFORNIA DEPARTMENT OF SOCtAL SERVICES CCLD RegloMI omc.. 101 GOlf COURSE DR. STE. A-230 ROHNERT PARK. CA 1·4128 6 1 1 2 3 1 2 ( STATE OF CAUFORHIA - HEALTH AND HUMAN $ERVtCES AGENCY FACILITY NUMBER: 283005477 VISIT DATE: 09122/2009 FACIUTY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENcY INFORMATION FOR THIS PAGE: Doflcloncy Type POC Due Date/ Section Number ·. FACILITY REPRESENTATIVI:SIGNATURE: -&:!- f/1{ t1/~ DATE: 09122/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. UCIOt (FAS) • (01104) P-o-; 1 ot3 ,, ..... STATE Of CAl.FOfttiA • HI!AL1lt All)~ 11E1MCE:1 JtDett:r CAL..FQIIarM DEPAJrTMENT r:w 80C1AL ~ COOIIIIHTY CARl! I.ICI!NMIO CMIION STA'11!0FCALF DATE: 01/28/2009 I acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. ~ ~~ DATE: 01/2812009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: FACILITY REPRESENTATIVE SIGNATURE: ~~~ DATE: 01/2812009 ~ ~ ~ ~ . This report must be available at Child Care and Group Home facilities for.p"t.biic review for.3 years. Pao-: 1 ol2 UCIOI (FAS) ·{01104) This Notice must be posted for 30 days Pau-:2ol2 UC*O(FASJ · ( - ) ' DATE: 01/2812009 ' STATE OF CALIFOR NIA - HEALTH AND HUMAN SERVICES AGENC Y CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUN ITY CARE LICENSING DIVISION CCLD Reg ional Office 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 10/01 /2009 CHILDREN'S COTIAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee , The following deficiencies , initially cited during a visit on 09/22/2009 , have been cleared : Date Due: 10/0212009 Section Cited : H&S 1596.8595(c) Plan of Correction: Corrections: I will go through all of the fi les and give a copy of all requi red citations Received copies of 9224 . Clearance Date: 09/30/2009 and Non-compliance conferences to parents . I will send a copy to Licensing by 10/2/09. LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 10/01 /2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) - (04/05) Page: 1 of 1 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 10/01 /2009 CH ILDREN'S COTTAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee, Th e following deficiencies, initially cited during a visit on 09/22/2009 , have been cleared : Section Cited : 101238 a Plan of Correction : The board will be made secure by 10/2/09. Section Cited : 1596.866 a Plan of Correction : I will have any staff that needs to take the classes to do so to ensure that there is someone present at all times with 15 hours health and safety. I will send a copy of proof of enrollment in the next available classes and send a copy to Licensing by 10/2/09 and a copy of cards wen completed . LICENSING EVALUATOR NAME: Susan Keehn Date Due: 09/02/2009 Corrections : picture of correction received . Clearance Date: 09/30/2009 Date Due: 09/25/2009 Corrections: Receipt for classes was received for one staff person. Clearance Date: 09/30/2009 TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: ;xf DATE: 10/01 /2009 This report must be available at Child Care and Group Home facil ities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NONCOMPLIANCE CONFERENCE SUMMARY CCLD Regional Office, , CA NAME AND ADDRESS OF FACILITY: CHILDREN'S COTIAGE- PRESCHOOL 1078 EAST AVENUE NAPA, CA 94559 FACILITY LICENSE NUMBER: 283005477 EFFECTIVE DATE OF LICENSE : LICENSE CAPACITY: 05/21/2004 FACILITY TYPE: ISTATUS: 3 45 850 LICENSEE NAME(S). CHILDREN'S COTIAGE CHILD CARE INC. ' NAME AND FACILITY NUMBER OF OTHER COMMUNITY CARE, CHILD DAY CARE , RESIDENTIAL CARE FACILITIES FOR THE ELDERLY, OR HEALTH FACILITIES LICENSED TO OR OWNED BY APPLICANT(S) WITHIN THE LAST FIVE YEARS . FACILITY NUMBER FACILITY NAME A. Children's Cottage- Child-Care , Inc. B. Children's Cottage C. Children's Cottage D. E. F. DATE OF CONFERENCE: 08/31/2009 Preschool Toddler Component Infant Preschool - Inactive LICENS ING PROGRAM ANALYST: 283005477 283006845 283005844 LICENSING PROGRAM MANAGER: Susan Keehn Present at meeting: NAME TITLE Linda Kryla Linda Walker Iris Hidalgo Susan Keehn Ray Welch Yasmin Solaria-Vallejo RM LPM LPA LPA Licensee Director at Lincoln Ave. LIC9111 (FAS) • (12199) ·(PUBLIC) Page : 1 of 4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NONCOMPLIANCE CONFERENCE SUMMARYPAGE2 CCLD Regional Office, , CA NAME AND ADDRESS OF FACILITY: CHILDREN'S COTIAGE- PRESCHOOL 1078 EAST AVENUE NAPA, CA 94559 FACILITY LICENSE NUMBER: 283005477 EFFECTIVE DATE OF LICENSE: 05/21/2004 LICENSE CAPACITY: STATUS: 45 FACILITY TYPE: 850 3 LICENSEE NAME(S): CHILDREN'S COTIAGE CHILD CARE INC. This Noncompliance Conference was called to discuss the following issues or deficiencies: 1 The Licensee's continued noncompliance with regulations since the non-compliance conference in March , 2 2008. Deficiencies have included issues with capacity , supervision, director qualifications, phys ical plant, and 3 record keeping . 4 5 Licensee has failed to make plans of correction time ly and has been assessed civil penalties 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 As the licensee, I understand and will comply with the plan of action described on this form. LICENSEE SIGNATURE DATE: ~ MANAGER SIGNATURE: 08/31/2009 DATE: 08/3 1/2009 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NONCOMPLIANCE CONFERENCE SUMMARYPAGE3 CCLD Regional Office, ,CA NAME AND ADDRESS OF FACILITY: CHILDREN'S COTIAGE - PRESCHOOL 1078 EAST AVENUE NAPA, CA 94559 FACILITY LICENS E NUMB ER: 283005477 EFFECTIVE DATE OF LICENSE: 05/21/2004 LIC ENSE CAPAC ITY: FACILITY TYPE: STATUS: 45 3 850 LI CENSEE NAME(S): CHILDREN'S COTIAGE CHILD CARE INC. Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates: 1 Licensee agrees to remain in compliance with Title 22 Regulations effective immediately. Licensee states he 2 has hired more qualified teachers , will have regular training for staff, at least monthly, more staff meetings which 3 include review of regulations , will download and review regulations on a regular basis, convert to using standard 4 state forms. Any future citations given by LPA"S must be followed, completed and corrected by due dates 5 given. 6 7 Licensee's facility will be placed on the Required Visit list and receive at least one comprehensive visit each 8 year. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 As the licensee, I understand and will comply with the plan of action described on this form . LICENSEE SIGNATURE DAT E: ~ MANAGER SIGNATURE: 08/31/2009 DATE: 08/31/2009 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NONCOMPLIANCE CONFERENCE SUMMARYPAGE4 CCLD Regional Office, , CA NAME AND ADDRESS OF FACILITY: CHILDREN'S COTIAGE- PRESCHOOL 1078 EAST AVENUE NAPA, CA 94559 FACILITY LICENSE NUMBER: 283005477 EFFECTIVE DATE OF LICENSE: 05/21/2004 LICENSE CAPACITY: STATUS: FACILITY TYPE : 3 45 850 LICENSEE NAME(S): CHILDREN'S COTIAGE CHILD CARE INC. Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this Department taking the following action{s): 1 Continued non- complance issues and deficiencies will result in an administrative action . 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 0 A detailed letter regarding this conference will be mailed to the licensee within 5 calendar days. As the licensee, I understand and will comply with the plan of action described on this form . LICENSEE SIGNATURE DATE: 08/31/2009 MANAGER SIGNATURE: DATE: 08/31/2009 [ill STAJ F CALIFORNIA-HEALTH AN D HUMAN S 'ICES AGENCY DEPARTMENT OF SOCIAL ~RVICES CDSS 101 Golf Course Dr. , Ste.A-230, Rohnert Park, CA 94928 Phone : (707)588-5026 Website: www.ccld .ca.gov JOHN A . WAGNER DIRECTOR ARN OL D SC I IWA RZEt August 11, 2009 Children 's Cottage , Inc. 1078 East Ave Napa , CA 95448 #283005477 Dea r Licensee : The policy of the Community Care Licensing Division is to ensure that licensees are afforded an opportunity to correct deficiencies prior to our taking more serious adm inistrative action. W ith the exception of situations where an immediate danger to cl ients exists , staff from the District Office will work with the licensee to gain compl iance and whenever possible, prevent the closure of the facility. In order to accomplish this goal, a Non-Compliance Conference is held with the licensee prior to referring a case for legal action . Due to problems that currently exist at your facility ; we would like to give you an opportunity to bring your facil ity into compl iance. Therefore, we have schedu led a conference with you on August 25 at 10 am in Community Care Licensing Office, Rohnert Park, CA 94928. Your attendance at this conference is mandatory. The purpose of the conference is to discuss the existing deficiencies, any current problem areas in the operation of your facility, the seriousness if the situation and the legal action which will be taken by the Department if the situation is not corrected. Your continued noncompliance will result in a referral for legal action, so it is extremely important that all deficiencies be corrected in a timely manner. A member of your Board of Directors is also required to attend th is meeting, preferably the President or Vice President. Please have your current administrator attend. Also, if you are unable to keep this appointment, please contact Susan Keehn at 707-588-50 26 or Linda Wal ker @ 707-588-5034 immediately so we may reschedule it as soon as possible. Sincerely, ~~ Linda Walker Licensing Program Manager ,j (} l FRN I •R r Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On February 2, 2009 Licensing Evaluator Iris Hidalgo came to Children's Cottage at the above address and license number. The facility was cited for the following violation: Control Number 01-CC-2008091 0103919 Type B 101223(a)(3) Child kept on potty chair a long time The regulation says a personal right of the child id to be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toi!eting; or withholding of shelter. clothing, medication or aids to physical functioning. Plan of Correction: We will review and follow the regulation. A child must never be kept on a toilet or potty for so long that they cry and become upset. I understand and will follow the regulation. This information, along with all of my previous instruction, gives me additional training on personal rights of children. February 3, 2009 RayW~ Mary Welch ~ ( j..,_).,.J2J.._ Susana Reyes ~ Heather Grah Lisa Crane (1) Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On February 2, 2009 Licensing Evaluator Iris Hidalgo came to Children's Cottage at the above address and license number. The facility was cited for the following violation: Control Number 01-CC-20080910103919 Type B 101428(e)(2) Potty chairs outside The regulation says after each use, the potty chair shall be promptly emptied into a flushing toilet, and all surfaces shall be thoroughly cleaned and disinfected. Plan of Correction: Since there is no flushing toilet outside, no more potty chairs outside Type B 101216(c) A volunteer was used to give breaks The regulation says the licensee may utilize volunteers provided such volunteers are supervised and are not included in the center's staffing plan. Plan of Correction: We will review and follow the regulation. The volunteer referenced in the violation has not been volunteering at our center since September 2008. If she does come back, it will be in accordance with the above regulation. (2) Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On January 14, 2009 Licensing Evaluator Iris Hidalgo along with LPM Linda Walker came to Children's Cottage at the above address and license number. The facility was cited for the following violation: Control Number 01-CC-20090107163741 Type B 101238(a) Plumbing problems Plan of Correction The problems was corrected as soon as they were known. The following staff reminder was given to all staff: Dear Staff: If for some reason the sink is temporarily out of order the prefen:ed method for · cleaning hands is soap and water instead of hand sanitizer (1) DEPT. OF SOCIAL SERVICES ROHNERT PARK REGIONAL OFFICE JAN 2 8 2009 COMMUNITY CARE LICENSING Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On January 14, 2009 Licensing Evaluator Iris Hidalgo along with LPM Linda Walker came to Children's Cottage at the above address and license number. The facility was cited for the following violation: Control Number 01-CC-20080910103919 Type B 101238(a)(l) Kitchen, Auditorium, and Bathroom in Auditorium are dirty. Plan of Correction Carpets will be shampooed every four months. They should be done ideally on a Friday night to allow them to dry completely over the weekend. Manzano Janitorial is scheduled for Fri Jan 30. Refrigerators will be thoroughly cleaned monthly. Microwaves will be thoroughly cleaned weekly. Type B 101223(a)(l) Potty chairs used in an area where children are playing Plan of Correction The potty chairs are important to the 2 year olds since they are in a developmental stage where potty training is part of their "curriculum." Moving the potty chairs from the playground up onto the outdoor ramp provides them with more privacy and they are still easily in sight of teachers. (2) Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On January 14, 2009 Licensing Evaluator Iris Hidalgo along with LPM Linda Walker came to Children's Cottage at the above address and license number. The facility was cited for the following violations: Type B 101170 Plan of Correction: Staff fingerprint clearance not associated with the facility Fingerprint transfer Request completed and mailed the same day Type B 101238(a) Plan of Correction: Outside storage cabinet with Lysol unlocked Cabinet was locked during visit Type B 101238(a) Plan of Correction: Metal rods exposed on playground Rods p0unded·down during visit so children could nc.t trip Type B 101238(a) Plan of correction: Holes in bathroom walls caused where door handle hit sheet rock wall Holes repaired Jan16 and door stop put in so door handle will not hit walls Type B 101238(c) Plan of Correction: Laundry room accessible by 2 doors. Only one had an eye & hook lock. The other door actually does have an eye & hook lock but it is on the inside (other side) of the door. It is locked and the laundry room is not accessible to children (3) SOCIAL SERVICES DEPT. Of _, REGION~L OfFICE ROHNERT PA"" JAN 2 8 {.009 COMMUN'TY CARE UCENS,NG Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On January 14, 2009 Licensing Evaluator Iris Hidalgo along with LPM Linda Walker came to Children's Cottage at the above address and license number. The facility was cited for the following violations: Type B 101238(a) Plan of Correction: Dirty rugs Rugs to be shampooed by Manzano Janitorial Jan 30 Type B 101439(h)(4) Changing table is not within an arm' s length of a sink Plan of Correction: The steps of the wooden table are removed so it is no longer used as a changing table and no child has access to the table top. The table top is now used for sign in sheets and other items the teachers use in their supervision of the children. No diaper changing is done outside. (4) ,, STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 10/30/2008 CHILDREN'S COTTAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies , initially cited during a visit on 09/22/2008 , have been cleared : Section Cited: 101220.1 Date Due: 10/06/2008 Plan of Correction : Immunization information will be requested from the parents and available in the child's file by 10/6/08 . Corrections: LIC 9098 completed by Director Clearance Date: 10/01/2008 Section Cited: 101221 (8) Plan of Correction: Parents will be given forms to complete and these forms will be made available in the child's file by 10/6/08. Date Due: 10/06/2008 Corrections: LIC 9098 completed by Director Clearance Date: 10/01/2008 Section Cited: 101220(a) Plan of Correction: Parents will be instructed to have medical check ups for their children as soon as possible. If the child's medical check up can not be completed by 10/6/08 an appointment date will be submitted to CCL as to when the child is expected to be seen by their doctor. Section Cited: 101219(a) Plan of Correction : Parent will be given an admission agreement to sign today, 9/22/08. LICENSING EVALUATOR NAME: Iris Hidalgo Date Due: 10/06/2008 Clearance Date: 10/01 /2 008 Corrections : LIC 9098 completed by Director Date Due: 09/23/2008 Corrections: copy of document signed by parent sent to CCL Clearance Date: 09/22/2008 TELEPHONE : (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cloarod POC Lotter (FAS) • (04106) Pago : 1 of 1 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC 101 Golf Cou rse Dr. Ste . A230 Rohnert Park, CA 94928 10/30/2008 CH ILDREN 'S COTTAGE - PRESCHOOL 283005477 3382 CRYSTAL COURT NAP A, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee , The following deficiencies, initially cited during a visit on 09/22/2008, have been cleared : Section Cited : 101218.1(e)(1) Plan of Correction : Parent will be given Parent's rights form to sign. receipt will be placed in the child's file by 10/24/08. LICENSING EVALUATOR NAME: Iris Hidalgo Date Due: 10/24/2008 Corrections : Clearance Date: 09/24/2 008 copy of parent's signature acknowleding receipt of parent's rightrs received by CCL 1017/08 TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Lotter (FAS) • (04/05) Page : 1 of 1 STATE OF CALIFORNIA - HEALTH AN D HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING PROOF OF CORRECTJON(S) FACILITY NAME FACILITY NO. Chiidren's Cof-f-a e- freschoo/ ~83005"'/77 LICENSING EVALUATOR /r,'s J / 1-/t'da .:;o This form shall be used in conjunction with the Licensing Report (LIC 809) and is provided to the facility to verify the correction 0 of deficiency(ies) cited in a licensing visit to your facility on '1 / ~ ;;1.. /0 8 form will not prohibit the Licensing Evaluator from conducting follow-up :JiSits to :sure . The use of this th~~Ad~ficiencies are corrected . (See ' instructions on back of this fo rm) . DEFICIENCY(IES) SECTION NUMBER PROOF OF CO ~RECTI ON ~I ill /0/220. I aft' "n 5 2. 3. lliW Ill If cht'ld# 2) #b.)-H~ .. 1. _f_tn!!''ud ·z /012-2./(~) 11111!1 . PreaJm/ssicn Hett!M /1,~ child If-~ ~~-~ttl;#"& 101220 (a) Wt/ljen /t'lt:d,'cal tlSJml- cJ,itJ t/:6) #-8 1012..1'1 (a) L. # . .lldrnill_ll,L,_ AJ_teerne,lt -child -- - - - - IOIZ./8./ (e) (I) c.h;IJ 1i> 0 5. Pat~llfs R/ahfs- Rec. e!'pf 4. J 6. 7 .-- PHOTOCOPY \/ v •cERTIFICATION . / v T OTHER DATE CORRECTED 1 o/t /o ;o/t/0¥ 1 ~~~ / ol' q7'b2./o8' q/2i/o~ I --~- ·-··- - 8. 9. I certify, under penalty of perjury under the laws of the State of California, that the above is true and correct and that I have corrected all deficiencies above on or before the date(s) indicated . --~~--~~~~======~------------------------------------------------~~~D~AT~E-------,------- /0 -3 -ot! ftification -this x may be checked if there is no other means to verify that the deficiency has been corrected. By signing this form, the licensee is self-certifying that the corrections have been made . If the certification is related to fingerprints, include the name(s) of the individual(s) for wh ich the fingerprint card was submitted and insert the date submitted to the Department of Justice in the "Date corrected" column . PLEASE RETURN THIS FORM WITH YOUR PROOF OF CORRECTION(S) LIC 9098 (3100) ~ Control N~mber 01 -CC-20080910103919 STATE OF C~LIFORNIA · HEALTH AND HUMAN SERVICES AGENcY CALIFORNIA DEPAR"i'MENT OF SOCIAL SERVICES cOMMUNITY CARE LICENSING OMS ION COMPLAINT INVESTIGATION REPt)ltT (Cont) R8dwood E!mpln1 ct, 't01 Golf Coura• ~r. Ste. A230 Roh~ Park, ~-PGU FACILITY NUMa.!=R~ 283005477 VISIT DATE:-09/22/2008 FACILITY NAME: CHILDREN!S COiTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: .. Deficiency Type POC Due Date I Section Number PLAN·Of= 'CORRECTiONS.{POCs) DEFICIENCIES .. Type B 10/06/2008 Section Cited 101220.1 1 Immunizations-Immunization information Is missing. 1 Immunization lnfor'matiGO wlll be ·requested frnm 2 or incomplete for child #2, #6, and #7. 2 fhe parents and avall~ble In the child's file by 3 3 10/6/~& 4 4 5 5 ' 6 6 7 7 Type B 10/06/2008 Section Cited 101221(8) 1 Childs's RecordsJPar.ent's Report of a ·Child's 2 Preadmission Health·History Is missing for chid f/4; .. 3 #5, #7, anct#8. 4 5 6 ,. 7 . ""' .. 1 Parents-win be;giV'en fol'fri·s to c;ortrpleteand th~se 2 forms will t)'EI mad& avaua·bte· In the <:hfld's file by 3 10/6'108. . 4 5 6 7 1 Child's Medical Assessment-Priorto, orw.ithl1'130 . · 1 2 calendar days following the enrollmeht of a Child, 2 Type B • 3 the licensee shall obtain a written medical 3 10/06/2008 4 assessment of the child. Child #6 and #8 have 4. Section Cited 5 been enrolled over 30 days. This document Is ndt 5 101220(a) 6 available in theire file. 6 7 7 1 Admission agreement-admission.agreement 2 missing for child #9 3 4 5 6 7 Type B 09/23/2008 Section Cited 101219(a) Type B 10/24/2008 Section Cited 101218.1(e)(1 ) . / ,. :- .. ;'t I ' ' . .. ...... ups=.for-'the.l.rchildrfin'tl!l·.soon-as·p.ossible. l.ftlie child's medical check UP.'I::pl'f41'0f be·t:ompfeted by 10/6/08 ~n appolntment.date-Will:be:submitted to CCL as to when the child is expecte,d-to-be seen by their doctor, 1 Parent will be given an-admlssiori agreement to '2 sign today, 9122108. 3 4 5 6. 7 .. -··· --..... .. ADMISSION PROCEI:>URES AND PA'RE:NTAL 1" :Piirent will be :glv~n Patent's rights form to sign. 2 receipt will be plated In the child's file by 10124/08. AND AUTHORIZED REPRESENTATIVE'S '~ RIGHTS-Parenfs Rights Receipt is not In the file of 3 child #10. 4 5 6 7 1 2 3 4 5 6 7 . 1 2 3 4 5 6 7 5 6 · 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Paren~ -wiir ~4l'\str:ttet~$1a ·ha~4}-m~dlcal check . ' 1 2 3 4 " 1 2 3 I I 4· 5 6 7 ~ ' . ~ .. . . -- · ____ ,... :- STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY J CALIFORNIA DEPARTMENT OF SOCIAL SERVICES PENALTV REVIEW Date : 10/7/2008 Facility Name: Children's Cottage - Pre Facility Number: 283005477 Invoice Number: _ _ _ _ _ _ _ __ CHILDREN'S COTTAGE- PRESCHOOL 1078 EAST AVENUE NAPA, CA. 94559 L _j DEAR LICENSEE : Per your request of _9_12 _6_1_ 0_8_ _ _ _ _ _ , a review was made of the following Deficiency and/or Penalty Notices: #1: 101212(d)1 (C)- Reporting Requirements; #2: 101223(a)3- Personal Rights; #3 101216(g)3(8)- Personnel Requirements; #4: 101216(g)3(A)- Personnel Requirements ; #5: 101221 (b)8(C)- Child's Records ; #6: 101221 (a)- Child 's Records You also appeal that these were all cited as "Type A" deficiencies but argue that all should be considered "Type 8" . The results are as follows : 0 Penalty Assessment Dism issed 0 Penalty Assessment Amount amended to $_ _ _ _ _ _ __ 0 Extension of Correction Due Date Approved to -------;-:;--;-:-;------- C Extension Date Denied i;/1 Request Denied (date) 10/7/08 DATE OF REVIEW DECISION Explanation: #1: any incident where skin is broken, especially from a bite, is a reportable incident. Regulation does not require treatment by a "Licensed Medical Professional" . #2: not only is 'infli ction of pain' a violation , but same section A(2} refers to 'safe accommodation! #3 & #4: You admit the required documentation was absent from this staffs file, thus admitting the violation . #s 5 & 6: again you District Manager/Delegate LIC 178 (5199 ) r--- /' Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On September 22, 2008 Licensing Evaluator Iris Hidalgo came to Children' s Cottage at the above address and license number. The facility was cited for the following violation which we would like to appeal: Type A 101223(a)(3) "Personal Rights Child are to be free from infliction of pain. A child has bitten children three times. The injury resulted in teeth marks and broken skin." The evaluator is speaking about an incident report dated Sept 1Oth. The injury report noted 3 times that a child bit other children on that day. When speaking to the parent she said the child was having a tough time that day with teething. Only one of the incidents broke the skin and the bite did not require treatment by a licensed medical professional. Biting is a natural part of a child' s development, especially during teething. For the 15 years we have been in business we have dealt with children who bite by watching them even more closely, shadowing them, catching them being good, using brief time outs when they bite, setting limits when they are playing, and informing parents of their child' s behavior as well as providing the parents with literature on biting. In the Evaluator Manual 3-4200 p 7 under Personal Rights it states " .. .include violations such as: physical abuse, sexual abuse, verbal abuse, neglect, witholding food and water, the inappropriate use of restraints, locking clients/children in buildings (without licensing approval); the use of corporal punishment and the failure to safeguard the cash resources an/or valuables of those in care." In this case, a child biting another child does not constitute a violation of personal rights. (2) / r-- r"' Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On September 22, 2008 Licensing Evaluator Iris Hidalgo came to Children' s Cottage at the above address and license number. The facility was cited for the following violation which we would like to appeal: Type A 101216(g)(3)(B) "Personnel Requirements-Volunteers are required to have a TB clearance. A volunteer at this center has been working Without a TB clearance. This information is not available In their file. " Our senior citizen volunteer has a TB clearance and is in good health. This information was not in her file. The analyst was at our center on September 22. The volunteer was not present and had not helped out at the center since September 5. She will not return until she has provided us with a copy of her TB clearance. In the Evaluator Manual3-4200 p 9 under Record Keeping it states "Failure to provide documented verification of staff qualifications ... staff medical assessments ... no client medical records" are type B violations. The volunteer had not been at the center for over 2 weeks prior to the licensing visit and will not be allowed to volunteer until she has a TB clearance. In this instance, there was no violation on September 22 or at the very most it was a Type B Record Keeping violation. (3) r- r- Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On September 22, 2008 Licensing Evaluator Iris Hidalgo came to Children' s Cottage at the above address and license number. The facility was cited for the following violation which we would like to appeal: Type A 101216(g)(3)(A) "Personnel Requirements-Volunteers need to submit a Statement that they are in good health. This information is not available in the file of a volunteer." Our senior citizen volunteer is in good health. This information was not in her file. The analyst was at our center on September 22. The volunteer was not present and had not helped out at the center since September 5. She will not return until she has provided us with this information. In the Evaluator Manual3-4200 p 9 under Record Keeping it states "Failure to provide documented verification of staff qualifications .. . staff medical assessments" are type B violations. The volunteer had not been at the center for over 2 weeks prior to the licensing visit and will not be allowed to volunteer until she has submitted a statement that she is in good health. In this instance, there was no violation on September 22 or at the very most it was a Type B Record Keeping violation. (4) r-- ~ Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On September 22, 2008 Licensing Evaluator Iris Hidalgo came to Children' s Cottage at the above address and license number. The facility was cited for the following violation which we would like to appeal Type A 101221(b)(8)(C) "child' s Records-Medical consent missing for child #7" In the Evaluator' s Manual 3-4200 p 9 under Record Keeping it states " ... lack of admission agreements, immunization records, staff medical assessments, needs and services plans; no record of client's personal and incidental funds; or no client medical records" are examples of Type B violations. The child' s parent signed the form while the Evaluator was still at the center. In this instance, there should be no violation or at the most it should be a Type B violation. When Mary Welch tried to show the Evaluator the above information on Record Keeping in the Evaluator Manual, the Evaluator said she could cite the center for an "A" violation if she wanted to and the Evaluator refused further discussion on the matter. (5) ,.-... ~ Children's Cottage Preschool & Child Care 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 On September 22, 2008 Licensing Evaluator Iris Hidalgo came to Children' s Cottage at the above address and license number. The facility was cited for the following violation which we would like to appeal: Type A 101221(a) "Child' s Records-Separate, complete, and current record must be kept for each child. This information is missing for child #8." In the Evaluator' s Manual3-4200 p 9 under Record Keeping it states " . . .lack of admission agreements, immunization records, staff medical assessments, needs and services plans; no record of client's personal and incidental funds; or no client medical records" are examples of Type B violations. The child' s parent signed the form while the Evaluator was still at the center. In this instance, there should be no violation or at the most it should be a Type B violation. On August 4, 2008 Children' s Cottage hired a Director in Training for the specific purpose of making our center "violation free." Her main emphasis was on keeping files accurate and up to date. Her performance was sub-standard and we had to terminate her on September 9. When she was told she was being let go she became angry and abusive. She told several employees that she was going to call CCL to complain. On September 11 , Ray Welch called the Evaluator to give her a "heads up" that Children' s Cottage had an angry ex-employee who was very upset about being terminated. The irony is that the things that the terminated employee complained about were the very things that she was hired to fix and had failed at. (6) r .... t" Children's Cottage Child Care, Inc 1078 East Avenue, Napa Ca 94559 Phone (707) 224-3825 Fax (707) 226-8118 License numbers 283006844 & 845 Iris Hildago Community Care Licensing 101 Golf Course Drive #A-230 Rohnert Park, CA 94928 August 18, 2008 Dear Iris: Regarding the toddler playground at 1078 East Avenue ... We have purchased a portable fence to divide the yard in half so that the toddler option children will not be combined with the two year olds. Because of the dynamics of the yard (one side having the sand box and climbers, and the other side having the ride-on toys) we have decided to have the toddler option children use one side in the AM and the other side in the PM and vice-versa with the two year olds. This way the children will not be combined and all of their developmental needs will be met. I hope you agree that this is a good solution for everyone. Here is the schedule: 7:00AM to I 2:00PM Toddlers use section A Two' s use section B I 2:00PM to 6:00PM Toddlers use section B Two' s use section A Thank-you, / m~ u/~ Mary Welch r- r Children's Cottage Child Care, Inc 1078 East Avenue, Napa Ca 94559 Phone (707) 224-3825 Fax (707) 226-8118 License numbers 283006844 & 845 Iris Hildago Community Care Licensing 101 Golf Course Drive #A-230 Rohnert Park, CA 94928 June 26, 2008 Dear Iris: Regarding the toddler playground at 1078 East Avenue ... We have purchased a portable fence to divide the yard in half so that the toddler option children will not be combined with the two year olds. Because of the dynamics of the yard (one side having the sand box and climbers, and the other side having the ride-on toys) we have decided to have the toddler option children use one side in the AM and the other side in the PM and vice-versa with the two year olds. This way the children will not be combined and all of their developmental needs will be met. I hope you agree that this is a good solution for everyone. ~ Thank-you, . <• Mary Welch /llt <.__ - ~,~ ... P.S. Fire Drill today at 3PM log posted ' r--- r-- STATE OF CALIFORNIA-HEALTH AND HUMAN SE:.MCES AGENCY Arr .IJ Schwarzenegger. Governor DEPARTMENT OF SOCIAL SERVICES 101 Golf Course Dr., Ste. A-230 Roh nert Park, CA 94928 CHILDREN'S COTTAGE - PRESCHOOL 3382 CRYSTAL COURT 06/24/08 APA-,-.CA--94558 OUTSTANDING APPLICATION FEE DUE: $25.00 !;;)EAR APPLICANT: lrr response to the current state budget deficit, the application and annual fees for all community care facilities have been increased effective August 16, 2004. The statutory authority for these changes can be found in Senate Bill 11 04. This affects the capacity increase/decrease as well. This change affects all pending applications and as a result, requires that you submit a check in the amount indicated above to the Community Care Licensing Division, which is the difference between the old and new fee for the facility type and capacity indicated on your application. This additional fee must be received in order to complete the processing of your application. Please include a copy of th is letter to assist us in applying this fee to your application . Please contact this office if you have any questions. Sincerely, Community Care Licensing/Support Staff Phone: 707-588-5026 ·\:§: l ;;t,. iJ.J Q =;:;L'F : "... :. ·:'•. \ 1'.8)! !;:(1,; 1.:a"t"'.t.: ':, \ trW'~.·~lQ' ,,... , r. ~I .. ;, \ r' r- Children's Cottage Child Care, Inc. 1078 East Avenue, Napa CA 94559 (707) 224-3825 License 283005477 Preschool & License 283005478 School-age Ray & Mary Welch Carl Hockett Community Care Licensing 101 Golf Course Drive# A-230 Rohnert Park, CA 94928-1718 April 14, 2008 Dear Carl, Thank-you for meeting with Mary and I on April 11 at your Rohnert Park office. I appreciated having Regional Manager Linda Kryla and Myrtle Herin at the meeting as well. As we said at the meeting, we are experiencing problems and have questions and would appreciate any technical assistance to help us maintain compliance with the regulations. Regarding the Type A violation cited on 4/3/08 Section 101161 that capacity was exceeded because we had 57 preschool and toddler age children in care and the license capacity is 45: We told you that in 2005 we got approval of the adjoining cottage next door for school-age children when Myrtle Herin was the supervisor. We thought the new space acquired for the school-age kids would then be our only school-age space and the auditorium space for 50 children would go back to the former preschool use as it was when we purchased the property from the "Little Friends" previous owner. We want to be in compliance. As we discussed, our correction plan is to submit this cover letter, the first page of a new application requesting a change of capacity, a facility sketch for that auditorium room that will be going from school-age back to the former preschool use, the fire clearance form, and a $25 fee. Please let me know if there is anything else that you need. I truly appreciate your help on this matter. Sincerely, ~~ Ray Welch COMMUNITY CARE / UCENSING , / """--- ~~' r-- !(;/\()~ Children's Cottage Preschool (707) 224-3825 1078 East Ave, Napa ;---- Lie #283005477 4/4/08 We are appealing the 3 violations from the visit of 4/3/08. 1. 25 children during nap time under the supervision of 2 teachers. 1 teacher was attending to a child to help with toileting and the other teacher was attending to a restless child. The other children were all on their mats asleep. The state regulations says #101230 A teacher child ratio of one teacher supervising 24 napping children is permitted provided that the remaining teachers necessary to meet the overall ratio specified in section #1 012163 (a) are immediately available at the center. We were in fact following the letter of the law. We had a much lower ratio than what the regs require as most parents here know. We had 2 teachers to 25 kids, almost double what is required in one napping room. I do not see any way that we were out of compliance. There were other staff available to come in as needed. 2. License capacity exceeded: 57 pre-school and toddler children in care. License capacity is 45. In actuality we had 54, not 57 children in care per the narrative on page 2. It states there were 15 two-year olds, 8 toddlers, 21 Bumblebees, 9 Dragonflies, and 11 Butterflies. We have in heaven's name ever had 21 Bumblebees! We always have up to 12 children with Miss Lisa, and every parent here knows that. Per our sign-in sheet, Miss Lisa had 11 children which is what she was scheduled for that day. So 15+8+ 11 +9+ 11 =54. So this is just a mistake. Secondly, the classrooms in the office wing are licensed for 45 children but the Auditorium is licensed for an additional 50 children. Many parents remember when we bought the cottage next door to make a home for our school-age kids. In 2005 the Cottage became licensed under our existing school-age license #203005478. We told our analyst we would no longer have the big kids in the auditorium and it would be used for pre-school which is exactly what it was used for before we bought the "Little Friends" school. The license for the use of the auditorium from schoolage to preschool was never changed although we all knew that the reason we bought the cottage was to make a new space for the schoolage kids. I spoke with Barbara Lawler about this very issue on the phone over a year ago. It should be noted that although the auditorium is licensed for 50 children, as you know we only have 24 children there. This is certainly more attention to quality capacity which is why parents say that the space is the most beautiful pre-Kindergarten in Napa. 3. Disinfectants & toxins which state "keep out of reach of children" observed accessible to children in several classrooms. The disinfectants & toxins she is talking about are simple green cleaner, Lysol spray, and Lysol wipes. One teacher was wiping down a table after lunch and left the spray bottle on the table with simple green cleaning solution in the bottle. Simple green is non-toxic and the label states it is "the finest non-toxic cleaner in the world." We use some old recycled 409 spray bottles and write "simple green" with marker on them. If the analyst had asked, we would have explained that to her. Lysol spray & wipes we use are always kept out of reach of children. We have special small wooden shelves in each room placed there on purpose for these items so that they~ch of children ~~:Jc $~-9~, and readily available for quick cleaning and disinfecting. 9: RfDWOOD EMPIRE '('I 1 O DISTRICT APR 0 8 2008 ~ 04/08/2008 11:11 7072258118 r--.. CHILDRlNS COTT Children's Cottage Preschool (707) 224-3825 1078 East Ave, Napa PAGE 01 --.. Lie #283005477 4/4/08 Plan of Correction regarding 3 violations .from the licensing visit of 4/3/08. 1. 25 children during nap time under the supervision of 2 teachers. 1 teacher was attending to a child to help with toileting and the other teacher was attending to a restless child. The other children were all on their mats asleep. POC: Since this is being appealed, we feel there is no violation to correct. We will review naptime ratios with staff and follow these ratios. 2. License capacity exceeded: 57 pre-school and toddler children in care. License capacity is 45. POC: I am going to please ask again to change the license at the auditoriwn to pre-school, which it has been used as for since we got the cottage next door licensed for school~age . We humbly request your help to correct the records and do any necessary paperwork to get the license to reflect what we thought it did. 3. Disinfectants & toxins which state ''keep out of reach of children" observed accessible to children in several classrooms. POC: We photo-copied the label of the simple green bottle to show that it is "The finest non~ toxic cleaner in the World." We can photograph bow Lysol and Lysol wipes are stored out of reach of the children on small high wooden shelves. 0 ("""' Children's Cottage Child Care, Inc 1078 East Avenue, Napa License #' s 283005477 & 478 (707) 224-3825 780 Lincoln Ave, Napa License #' s 283006844 & 845 (707) 254-1856 2813 Solano & 2004 West Park Lie #' s 283007061 & 062 (707) 226-6115 February 1, 2008 Susan Keehn Community Care Licensing 101 Golf Course Drive #A-230 Rohnert Park, Ca 94928 Dear Susan, I am sending you the following documents to clear up any confusion regarding the designated directors of my centers. (1) Lie 500 "Personnel Report" for our East Avenue location showing Ray Welch as director along with "Evaluation of Director Qualifications" and photo copies of Ray's transcripts, etc. / (2) Lie 500 "Personnel Report" for our Lincoln Avenue location showing Yasmin Vallejo as director along with "Evaluation of Director Qualifications" and photo copies ofYasmin (Antonia) transcripts, etc. (\..c..c..cl Lt.:... 3 C8 .(3) ~c 500 "Personnel Report" for our new school location on Solano Ave which his a pending license, showing myself as director. My qualifications are included in the license packet for this school. (4) I am also sending along an Lie 9182 Transfer request with all the licenses just to make sure I will have clearance at all of them. Thank-you so much. Please let me know ifyou need anything else . ·~ ~1 / 2 9/ 200 8 18 : 32 7072268118 / CHILDRENS COTT fLJo: PAGE Olec n] :1() Children's Cottage Child Care, Inc 780 Lincoln Ave, Napa Carl Hockett Community Care Licensing lOt Golf Course Drive #A-230 Rohnert Park, Ca 94928 License #' s 283006844 & 845 01 (707) 254-1856 Jan 29. 2008 Dear Carl, I would greatly appreciate your immediate attention to this appeal. Yesterday Barbara Lawler came to our center to inspect the physical changes we made to our facility in order to obtain a toddler option which we requested last &It Barbara was very professional and courteous during her visit. During the inspection Barbara cited us for incorrect ratios in 2 rooms during naptime. The first citation was in the infant room. When Barbara entered the infant room there were 8 babies awake and 2 babies sleeping with 2 teachers in the room. My assistant director Yasmin Vallejo was in the office and available if needed in the infant room. She had been with the infants giving another teacher a break. .. I bad just called her into the office (ironically to go over ratios with her to make sure the ratios were appropriate) before I left for the day. She returned to the infant mom immediately after our discussion. What comes into play here is our understanding of the ratios. Barbara' s understanding is that once one child wakes up, the waking nrtios apply. This would mean that an infant room with 12 children where 10 were sleeping and 2 were awake would need 3 teachers for the room to be appropriate. A group of 24 pre-school aged children with 23 napping and 1 child who gets up to go to the bathroom (Barbara' s example to me) would need 2 fully qualified teacben to supervise the 1 awake child. Common sense dictates that this is not the intention of the law. Nowhere in the regulations is this insinuated. But what is ve:ry clearly stated i:s separate ratios for napping children and awake children. I was working in early childhood programs in the early 1970's when this regulation was amended. The purpose of the naptime ratio change was to allow center-s to be able to fulfill the requirements of other state and federal laws, in particular to enable staff to receive necessary breaks. In the mid 1990' s this idea of 1 child awake changing the ratio got going in the bay area. I was a director in Fremont California at that time. In ordet to try and meet these requirements, centers established policies making cbildren "stay on their cots for 2 hours" / STATE OF CALIFORNIA-HEALTH AND HUM, / ERVICES ARNOLD SCHWARZENEGGER, Governor DEPARTMENT OF SOCIAL SERVICES CHICO REGIONAL OFFICE DcHICO OFFICE , 520 Cohasset Road , Suite 6, Chico CA 95926 Telephone: 530-895-5033 FAX: 530-895-5934 Serving : Butte, Colusa, Glenn , Lassen , Modoc, Plumas, Shasta , Sierra , Siskiyou , Sutter, Tehama , Trinity and Yuba counties 0ROHNERT PARK OFFICE, 101 Golf Course Drive , Suite A-230, Rohnert Park CA 94928 Telephone : 707-588-5026 FAX: 707-588-5099 Serving : Del Norte, Humboldt, Lake , Mendocino, Napa , Solano , and Sonoma counties September 5, 2006 Mary Welch Children's Cottage Child Care 1078 East Ave. Napa, CA 94559 Dear Ms. Welch , First let me apologize for the tardiness of our response to your appeal letter of April 28 of this year. I could cite many reasons for the delay, but there are no excuses. Please accept my apology. On the citation for Teacher-Child Ratio, Section 101216.3, you are correct in your read of the regulation. As long as all children were resting quietly, the napping ratio applies. Your appeal on this issue is granted and the citation is rescinded . I find there is more than adequate information derived from this investigation, including witness interviews, to support the both the findings and citations for Commingling and Limitations on Capacity. I agree, there appears to be some confusion so I'll try to clarify here. You have two licenses, not three; one school-age and one preschool with a toddler option. Separation of these three components must be maintained at all times, with the specific exceptions set out in regulation . When commingling during the first and last hours of the day, this is the limitation: one hour only. During any time that children from separate programs are commingled, staffing ratio must be maintained according to the youngest children present. Eg . You have toddlers, preschool and school-age mixed. Ratio would be 6 to 1. Your letter does not break down the children's numbers by program , only age. If the two-year-aids were enrolled in the Toddler option , then toddler ratio applies. If they're enrolled in the preschool , then preschool ratio applies. Please note that regulation allows flexibility in the placement of children between certain ages (whether they are toddler or preschool), but it does not allow for capricious application to suit the center's needs. A child is assessed and an appropriate placement is determined, and the child is enrolled in that program , and stays with that program until a formal reassessment is made for a different placement. As to the citation for Limitations on Capacity, your Preschool (including Toddler option) is licensed for 45 children . On the date of that visit, 4/21/06, you had 62 children present under the preschool license. This is a clear violation of the licence and the citation is upheld. If you wish to increase the capacity of your license by incorporating the former school-age use gymnasium , you must submit an application for a room addition . We will inspect and determine Page 1 of 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT REDWOOD EMPIRE CC , 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE CHILD CARE , INC. - INFANT ADMINISTRATOR: SOLORIO-VALLEJO, YASMIN ADDRESS : 1078 EAST AVENUE CITY: NAPA STATE: CA CAPACITY: 20 CENSUS: 15 Case Management UNANNOUNCED TYPE OF VISIT: Ray Welch MET WITH : 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 FACILITY NUMBER: FACILITY TYPE : TELEPHONE : ZIP CODE : DATE: TIME BEGAN: TIME COMPLETED: 283007874 830 (707} 224-3825 94559 11/17/2009 11:00 AM 01 :30PM NARRATIVE Complaint Specialist- LPA Terri Jensen conducted an unannounced facility visit for the purpose of delivering case management citations that were noted during a facility visit on 11-16-09. Due to a commitment,CS Jensen was unable to provide written citations. Note however, that the citations as well as plans of correction were discussed with Director Ray Welch. See LIC 809D for citations issued during this visit. NOTICE OF SITE VISIT POSTED APPEAL RIGHTS AND NEVER SHAKE A BABY BROCHURE GIVEN Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility within the next 24 hours or the next time the child is in care, and to parents/ guardians of children newly enrolled at the facility during the next 12 months. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707} 588-5055 LICENSING EVALUATOR NAME: Tern TELEPHONE: (707} 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC809 (FAS) - (06/04) Page: 1 of 2 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE CHILD CARE, INC. INFANT DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 11 / 17/2009 Section Cited 101223(2) FACILITY NUMBER: VISIT DATE: 11/17/2009 DEFICIENCIES 1 2 3 4 PERSONAL RIGHTS: Staff report that infants walk through the parking lot from the outdoor play area to return to their room . This is not considered safe. as there are 8 infants and two staff, which 5 does not allow an adult to physically secure each 6 child's safety. Staff report a concern about this 7 practice. 283007874 PLAN OF CORRECTIONS(POCs) 1 2 3 4 We will no longer use the parking lot to return children to their classroom . This will be discussed at the Dec. 3, 09 staff meeting. A written summary of our discussion regarding the potential for risk as 5 a result of this practice will be submitted to 6 licensing along with a list of all staff in attendance. 7 1 1 2 3 4 2 3 4 5 6 5 6 7 7 1 2 3 4 1 2 3 4 5 6 5 6 7 7 1 2 3 4 1 2 3 4 5 6 5 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Terri r.o! e.,.,.,.,.,.....--'"'-A TELEPHONE: (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 11/17/2009 This Notice must be posted for 30 days LIC809 (FAS)- (06/04) Page : 2 of 2 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 11/17/2009 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 11/20/2009 Section Cited 101212(e)(4) Type B 11/23/2009 Section Cited 101173 DEFICIENCIES PLAN OF CORRECTIONS(POCs) REPORTING REQUIREMENTS : The licensee failed to report a change in the plan of operation that affects services to children , when he failed to notify licensing that a portable toilet was brought to 5 the outdoor activity area for use. 6 1 I will cease using the portable toilet until such time 2 that licensing is notified and can inspect the 3 portable toilet for health and safety. 4 5 6 7 7 1 2 3 4 1 2 3 4 PLAN OF OPERATION: The licensee failed to get Department approval prior to implementing the plan for utilizing a portable toilet in the outdoor activity area . 5 6 7 1 2 3 4 I will cease using the portable toilet until such time that I have submitted an amendment to my plan of operation to include the plan for using a portable toilet in the outside activity area and until such time 5 that this plan is approved by the Department. 6 7 1 2 3 4 1 2 3 4 5 6 5 6 7 7 1 2 3 4 1 2 3 4 5 6 5 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Terri Jens TELEPHONE: (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~;!1L LIC809 (FAS) • (06/04) DATE: 11 /17/2009 Page: 3 of 4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visiUinvestigation of a complaint received in our office on 11/04/2009 and conducted by Evaluator Terri Jensen PUBLIC COMPLAINT CONTROL NUMBER: 01 -CC-20091104123501 FACILITY NAME : CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 35 UNANNOUNCED MET WITH: Ray Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 11/17/2009 11 :00 AM 01:30PM ALLEGATION(S): 1 PHYSICAL PLANT: Door broken, allowing children to go in and out. 2 LACK OF SUPERVISION: Children putting their heads in the refrigerator. 3 TEACHER CHILD RATIO: Ratio exceeds 1 to 12 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Complaint Specialist- LPA Terri Jensen conducted an unannounced facility visit for the purpose of 2 delivering final findings for the above stated allegations. 3 This investigation consisted of personal interview with director and assistant as well as personal private 4 interviews with four staff, tour of the physical plant and inspection of all door and observations made during a 5 facility visit on 11-16-09. Investigation findings reveal that a door in the infant room , leading to the outdoor 6 activity area does not close securely unless lifted and pulled on hard. Frequently,when the door appears 7 closed it can be pushed open without turning the knob. Staff report that they were aware of the malfunctioning 8 in the door and reported their concern to the director. During the visit on 11-16-09, CS Jensen observed that 9 the door was in need of repair. This allegation is substantiated. 10 Investigation findings reveal that there are two "play" refrigerators in the center in two separate 11 classrooms. These refrigerators are made of wood with doors that open and close. The inside of the 12 refrigerator is large enough to hold a small child . Staff report that children "tending to crawl inside because it's 13 a hiding place" and children close the doors on each other. Staff report that children have had their Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Terri Je TELEPHONE: (707) 494-8334 DATE: 11 /17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 11/17/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC9099 (FAS) • (06/04) Page: 1 of 4 Control Number 01-CC-20091104123501 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 11/17/2009 NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 fingers smashed in the door as a result of this play in the child sized toy refrigerators . All staff report that it is against the rules to climb in the refrigerator. Staff report that the children do it anyway, "when they know that the teachers aren't looking." This constitutes a lack of supervision by staff. The risk to a child being harmed as a result of this type of unsupervised play is serious. This allegation is substantiated. A civil penalty is being assessed as Responsibility for Providing Care and Supervision was previously cited in the last 12 months on 9-22-09. Investigation findings reveal that staff have been left with a ratio of one teacher to more than 12 children. This occurs primarily in the morning at drop off. In adequate staff are on duty for the number of children expected making it necessary for staff to have to call for a director to rearrange staff to ensure the ratio is incompliance. Sometimes this may only take a few minutes, other times it may take up to 10 minutes or more to secure a substitute. Other examples include instances when ·census in the infant room required additional staff, teachers were pulled from the preschool to cover the infant room , leaving a ratio of 1 to 14 in the preschool. It was also reported that teachers have been pulled from the classroom to do office work, leaving the ratio out of compl iance. The ratio ha s also been off at nap time, when 26 to 27 children have been supervised by one teacher. (See case managem ent for this citation) . Th is allegations is substantiated. See LIC 9099D for citations issued during th is vi sit. NOTICE OF SITE VISIT POSTED APPEAL RIGHTS AND NEVER SHAKE A BABY BROCHURE GIVEN Upon receipt, licensee shall post for 30 days and provide copies of th is licensing report to parents/guardians of children in care at the facility within the next 24 hours or the next time the child is in care , and to parents/ guardians of children newly enrolled at the facil ity during the next 12 months. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: T ~~=-7v--:----. TELEPHONE: (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/1 7/2009 LIC9099 (FAS)- (06/04) Page: 3 of 4 Control Number 01-CC-200911 04123501 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) REDWOOD EMP IRE CC , 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number FACILITY NUMBER: 2830054 77 VISIT DATE: 11/17/2009 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 The door was repaired during the visit on 2 November 16, 2009. I removed the metal plate repair at all times. Many staff were aware of a door 3 and lowered it in order the latch on the door knob to 4 catch securely. CS Jensen inspected this in the infant room that did not close securely and could be a potential risk to a child in the event that 5 correction during the visit and the correction was 6 deemed satisfactory. I will routine check the a child left the building . It was report to the 7 building to ensure good repair. director who failed to repair it. 1 BUILDINGS AND GROUNDS : The licensee failed Type A 11/16/2009 Section Cited 101238(a) 2 to ensure that all parts of the building are in good 3 4 5 6 7 Type A 11/17/2009 Section Cited 101229(a)(1) 1 RESPONSIBILITY FOR PROVIDING CARE AND 2 SUPERVISION: Staff report that children are 3 playing with toy refrigerators and in an 4 inappropriate and unsafe manner, causing potential 5 risk to children . This play occurs when teachers 6 are not visually supervising the children . Civil 7 penalty assessed . 1 I will provide an in-service, mandatory, training for 2 all staff RE supervision techniques by 3 12-3-09. I will submit a written summary of the 4 training and a list of all staff in attendance. I will 5 immediately remove the doors from both 6 refrigerators and/or remove the items completely. 7 Type A 11/17/2009 Section Cited 101216.3 (a) 1 TEACHER CHILD RATIO: Staff report a variety of 1 I will provide training on 12-3-09, to all staff alerting 2 instances when the teacher child ratio is out of 2 them that children shall not be accepted for care at 3 any time when there is insufficient staff present to 3 compliance, exceeding 1 to 12. 4 meet the ratio requ ired by Title 22. I will submit a 4 5 written summary of the training and a list of all staff 5 6 in attendance. 6 7 7 1 2 3 1 2 3 4 4 5 6 7 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: {707) 588-5055 LICENSING EVALUATOR NAME: Terri Jensen TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~ DATE: 11/17/2009 This Notice must be posted for 30 days LIC9099 (FAS) - (06/04) Page : 2 of 4 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) REDWOOD EMPIRE CC , 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 11/04/2009 and conducted by Evaluator Terri Jensen COMPLAINT CONTROL NUMBER: 01-CC-200911 04123501 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: 64 CENSUS: CAPACITY: UNANNOUNCED MET WITH: Ray Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 11/17/2009 11 :00 AM 01 :30PM ALLEGATION(S) : 1 LACK OF SUPERVISION: Children running in parking lot unsupervised . 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Complaint Specialist - LPA Terri Jensen conducted an unannounced facility visit for the purpose of 2 delivering final findings for the above allegation. 3 This investigation consisted of personal interviews with director and assistant director, personal , private 4 interviews with four staff, observations made during the visit and inspection of the physical plant. 5 Investigation findings reveal that the parking lot is typically not used as an area of play for children. 6 However, a Halloween parade took place in the parking look with a gate secure ly barricading access to the 7 street. Further an on site field trip from the fire department took place in the parking lot and fire drills also occur 8 in the parking lot. Staff report that the above described activities are well supervised with staff and parents. No 9 one has observed children running about unsupervised. As such this allegation is inconclusive. 10 However,staff do report a recent change in the plan operation whereby children enter their classroom 11 from the yard by walking around the building and through the parking lot. Staff do not feel this is completely 12 safe and presents a potential risk to children . (See Case Management Report for deficiency. NOTICE OF 13 SITE VISIT POSTED Inconclusive Estimated Days of Completion: SUPERVISOR'S NAME : Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Terri ~~1-l-f~~ TELEPHONE : (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~tZA-; ~ DATE: 11/17/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 4 of 4 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOC IAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT REDWOOD EMPIRE CC , 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS : 1078 EAST AVENUE CITY: NAPA STATE : CA CAPACITY: 64 CENSUS: 35 UNANNOUNCED Case Management TYPE OF VISIT: MET WITH : Ray Welch 1 2 3 4 5 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707 ) 224-3825 94559 11/17/2009 11:00 AM 01:30PM NARRATIVE Complaint Specialist- LPA Terri Jensen conducted an unannounced facil ity visit for the purpose of delivering case management citation that were observed during a facility visit on 11-16-09. Due to a commitment,CS Jensen was unable to provide written citations. Note however, that the citations as well as plans of correction were discussed with Director Ray Welch . See LIC 809D for citations issued during this visit. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 NOTICE OF SITE VISIT POSTED APPEAL RIGHTS AND NEVER SHAKE A BABY BROCHURE GIVEN Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility within the next 24 hours or the next time the child is in care, and to parents/ guardians of children newly enrolled at the facility during the next 12 months. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 TELEPHONE: (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~c»;tW~ DATE : 11 /1 7/2 009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS)- (06/04) Page: 1 of 4 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC , 101 GOLF COURSE DR . STE . A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 283005477 VISIT DATE: 11/17/2009 Deficiency Type POC Due Date I Section Number DEFICIENCIES Type A 11/18/2009 Section Cited 101229(A)(1) RESPONSIBILITY FOR PROVIDING CARE AND 1 SUPERVISION: Staff acknowledged to this worker 2 that the interior of the playhouse in the outdoor 3 4 activity area is not visable for supervision unless 5 one is standing right next to the playhouse. Staff 6 report children climb on the windows and door 7 opening . The play house is not always adequately supervised . 1 2 3 4 1 2 3 4 BUILDINGS AND GROUNDS: During a tour of the center,CS Jensen observed compounds with labels reading Call PoisonControl if swallowed.These are considered toxic and must be locked . These items 5 were on a medium height shelf, not immediately 6 accessible but reachable with a chair, but not 7 locked . 1 2 3 4 I now understand the definition of a toxic compount (Call Poison Control or Fatal if swallowed on label) and that toxins must be locked with a key or combination lock. I will lock all toxins with a key or 5 combination lock . I will submit a photo to licensing 6 of this plan of correction . 7 1 2 3 4 BUILDINGS AND GROUNDS : CS Jensen observed a hole in the cement on the walk way leading to the infant rooms and preschool room . Rebar is exposed and the hole is large enough to 5 provide a potential tripping risk to a child. 6 7 1 The hole is being repaired today (11-17-09). CS 2 Jensen inspected the plan of correction and found 3 it to be acceptable. 4 1 2 3 4 1 I will schedule two teachers for nap time as the 2 census has recently increased to over 24 children 3 at nap. 4 Type A 11/24/2009 Section Cited 101238(g)(1) Type A 11/30/2009 Section Cited 101238(a)(1) Type A 11/17/2009 Section Cited 101230(c) NAPPING ACTIVITIES: The licensee failed to maintain a teacher-child ratio of 1 teacher to 24 children during nap time, as well as to ensure that teachers necessary to meet over all ratio are 5 immediately available. The ratio has been 6 observed to be 1 to 26 or 27, 2 to 3 times a week 7 and staff are not available. PLAN OF CORRECTIONS(POCs) I will have the front of the play house removed . I have already consulted with experienced handy men who acknolwedged it can be removed and remain structurally sound and safe. I will send a 5 photo to licensing. 6 7 5 6 7 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Terri Je TELEPHONE: (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2009 This Notice must be posted for 30 days LIC809 (FAS)- (06/04) Page : 2 of 4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR . STE . A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 11/17/2009 Section Cited 101216.2 FACILITY NUMBER: 283005477 VISIT DATE: 11/17/2009 DEFICIENCIES 1 2 3 4 PLAN OF CORRECTIONS(POCs) TEACHER AIDE QUALIFICATIONS AND DUTIES: An aide shall only work under the direct supervision of a teacher. An aide was left to supervise 14 children alone, when the teacher was needed to 5 meet ratios in the infant room . 6 7 1 I will discuss ratios at the Dec. 3, 2009 staff 2 meeting with all staff. I will submit a summary of 3 the trai ning with a list of all staff who attended. 4 1 2 3 4 1 2 3 4 5 5 6 7 6 7 1 2 3 4 1 2 3 4 5 6 7 5 5 6 7 6 7 1 2 3 4 1 2 3 4 5 5 6 7 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. TELEPHONE: (707) 588-5055 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Terri Jen n TELEPHONE: (707) 494-8334 DATE: 11/17/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~~ DATE: 11/17/2009 This Notice must be posted for 30 days LIC809 (FAS) • (06/04) Page : 4 of 4 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: WELCH , MARY ADDRESS: 1078 EAST AVENUE STATE:CA CITY: NAPA CENSUS: 39 CAPACITY: 45 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH : Ray Welch , Licensee 1 2 3 4 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 10/14/2009 03:30PM 04:15PM NARRATIVE LPA S. Keehn visited the facility and requested a current roster. Present upon arriva l are 39 children with 5 staff. See 809 for deficiency. Notice of Site Visit is Posted . 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2009 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: z;<~ fl DATE: 10/14/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page: 1 of 2 ·J STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CH ILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type 8 11 / 13/2009 Section Cited H&S 1596.841 FACILITY NUMBER: 283005477 VISIT DATE: 10/14/2009 DEFICIENCIES 1 2 3 4 5 6 7 ROSTER OF CHILDREN The current roster does not include children who have disenrolled. This roster must be kept for 3 years after a child disenrolls. PLAN OF CORRECTIONS(POCs) 1 I will begin inputting the date a child leaves and 2 keep the information for three years. I will send a 3 copy to Licensing by 11 /13/09. 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE : (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE : J~ DATE: 10/14/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: --&_ 1 LIC809 (FAS) - (06/041 yJ~ DATE: 10/14/2009 Page: 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUN ITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR: WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CA CAPACITY: 45 CENSUS: 45 TYPE OF VISIT: Case Management UNANNOUNCED MET WITH: Ray Welch , Licensee 1 2 3 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 09/22/2009 11 :00 AM 05:00PM NARRATIVE LPA S. Keehn and LPM L. Walker met with Ray Welch , Licensee to do a comprehensive inspection . At that time , although a Type A violation was discussed with Mr. Welch , LPA forgot to cite until after the laptop was turned off. Aga in th is was discussed and Mr. Welch was informed that the citation would follow. 4 5 6 7 8 An amended Notice of Site Visit shou ld be posted for 30 days. See 809D for defic iency. Appeal Rights were given. Upon receipt, licensee shall post and provide copi es of thi s licensing report to parents/guardi ans of children in care at the faci lity and to parents/guardians of children newly enroll ed at the facility during the next 12 months. Failure to compl ete plan of correction may result in a ci vil penalty. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: ~~ · DATE: 10/02/2009 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2009 This report must be available at Child Care and Group Home faci lities for public review for 3 years. LIC809 (FAS) • (06/04) Page: 1 of 2 STATE OF CALIFORN IA· HEALTH AND HUMAN SERVICES AGENCY CALIFORN IA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CH ILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2009 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number DEFICIENCIES Type B 09/02/2009 Section Cited 101238 a 1 BUILDINGS AND GROUNDS A board on the 2 yellow play car in the preschool yard is dislodged 3 from bolt beneath the seat and wiggles. The length 4 of the board has areas with rough spots and poses 5 a tripping hazard. 6 7 4 5 6 7 Type B 10/02/2009 Section Cited 101216 g1 1 PERSONNEL REQU IREMENTS 5 out of 6 staff 2 records reviewed show that staff do not have timely 3 TB tests . All staff had a test, but they were up to 2 4 years after hire. (Staff 1,2,4,5,6). 5 6 7 1 Because TB testing was done after hire, no action 2 is needed except to ensure that all staff receive 3 timely Healthscreening and TB testing. 4 5 6 7 Type B 10/02/2009 Section Cited 101170d 1 CRIMINAL RECORD CLEARANCE . Of six records 2 reviewed , one had no LIC 508 in the file . (staff 6,) 3 and the other (staff 4) who was hired in 2006 4 completed the form in 2008. 5 6 7 1 I will ensure that all staff comp lete the necessary 2 paperwork when hired , includ ing the LIC 508. 4 5 6 7 Type B 09/25/2009 Section Cited 1596.866 a 1 The person who opens does not have the 15 hours 2 of req uired health and safety training which 3 includes pediatric CPR, First Aid , and Preventative 4 Health. Staff #2 needs the classes. 5 6 7 1 I wi ll have any staff that needs to take the classes 2 to do so to ensure that there is someone present at 3 all times with 15 hours health and safety. I will 4 send a copy of proof of enrollment in the next 5 available classes and send a copy to Licensing by 6 10/2/09 and a copy of cards wen completed . 7 PLAN OF CORRECTIONS(POCs) 1 The board will be made secure by 10/2/09. 2 3 3 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE : -a__ryN~ LIC809 (FAS) • (06104) DATE: 09/22/2009 Page: 3 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CH ILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 10/02/2009 Section Cited H&S1596.8595(c) FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2009 DEFICIENCIES 1 2 3 4 5 6 PARENT NOTIFICATION- AB633 Two files reviewed did not have the required parent notification of type A cigtations and other items required to be given to parents. PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 I will go through all of the files and give a copy of all required citations and Non-compliance conferences to parents . I will send a copy to Licensing by 10/2/09. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: ~~ DATE: 09/22/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~v;~ LIC809 (FAS) • (06/04) DATE: 09/22/2009 Page: 2 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTIIEHT OF SOCIAL SERVICES COMMUNITY CARE UCEHSING DIVISION R£DWOOD EMPIRE CC. 101 GOLF COURSE DR. STE.A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA 45 CENSUS: 45 CAPACITY: UNANNOUNCED TYPE OF VISIT: POC MET WITH: Ray and Mary Welch 1 2 3 4 5 6 7 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZJPCODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 02/0212009 02:30PM 03:30PM NARRATIVE A plan of correction visit was conducted today for the purpose of inspection the deficiencies which were cited on 1/28/09. At this time, the carpers have been cleaned. They are visually cleaner. The carpets were cleaned throughout the center. The plan of correction is that carpets will be cleaned every four months. Notice of Site Visit is posted. Shaken Baby Syndrome Brochure is given. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2009 I acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06104) P~ : 1 of1 / STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTIIENT OF SOCIAL SERVICES COIIMUNilY CARE I..ICENSlNG DIVISION FACILITY EVALUATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 948ZI FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CENSUS:45 CAPACITY: 45 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Ray and Mary Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 0210212009 02:00PM 02:30PM NARRATIVE A case management visit was conducted today. The majority of the children in care are napping. The center is within capacity guidelines. 1 2 3 4 5 On 9122108 a review of staff records was done. A volunteer was assisting at the school. Upon review of their file, a TB result was not available nor was there a statement of good health signed by the volunteer. Fingerprint clearances were available. 6 7 8 The play yard was inspected today as part of the visit. 9 10 11 12 13 14 15 A review of staff records on 212109 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. See 8090 for deficiencies cited during today's visit. Shaken Baby Syndrome Brochure is given. Notice of Site Visit is posted. 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: =lw~ DATE: 02/02/2009 I acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 7JiaAyU!~~ DATE: 02/0212009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06104) Page: 1 of2 STATEOFCAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE.A-230 ROHNERT PARK, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE: 02/0212009 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number TypeS 0210212009 Section Cited 101216(g)(3)(A) TypeS 0210212009 Section Cited 101216(g)(3)(S) DEFICIENCIES PLAN OF CORRECTIONS(POCs) Personnel Requirements-The good physical health of each volunteer who works in the center shall be verified by a statement signed by each volunteer affirming that he/she is in good health. This 5 document is not available. 6 1 All volunteers will complete a statement stating that 2 they are in good health. 3 4 6 7 7 1 2 3 4 Personnel Requirements-Good health for each volunteer will be verified by results of a test for tuberculosis performed not more than one year prior to or seven days after initial presence in the 5 center. 6 1 All volunteers will have TS results in their files. 2 3 4 7 7 1 2 3 4 1 Buildings and Grounds-The child care center shall TypeS 02/02/2009 Section Cited 101238 {a) CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION 2 3 4 5 6 7 be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. Two Clorox wipe containers are accessible to children. The containers are located on the shelf of a cabinet which was used as a changing table. A soiled 1 2 3 4 5 5 6 1 Clorox containers were relocated during the visit 2 and are inaccessible to children. Staff will be 3 reminded as to the proper disposal of soiled 4 clothes. The trash container was relocated on the 5 ramp. Potty chairs have been completely removed 6 from the outside. A Flex-Lok was attached to the 7 gate so that children can not open the gate. 1 I~ I 4 5 5 6 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 02/0212009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 0210212009 UC809 (FASl· (011104) Page: 2 of2 STATE OF CAUFORNIA ·HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR STE.A·230 ROHNERT PARK, CA 841128 This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/10/2008 and conducted by Evaluator Iris Hidalgo COMPLAINT CONTROL NUMBER: 01-CC-20080910103919 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR: WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CENSUS: 45 45 CAPACITY: MET WITH: 283005477 850 (707) 224-3825 94559 02/02/2009 01 :35PM 02:40PM ALLEGATION(S): 1 -Violation of Personal Rights-child was verbally intimidated to remain on a potty chair. The length of time 2 resulted in the child crying and becoming upset. 3 -Violation of Infant Care Services-Urine left in potty chair when next child uses the chair. 4 -Violation of Personnel Guidelines-Volunteer was supervising children 5 6 7 8 9 INVESTIGATION FINDINGS: 1 A complaint visit is conducted today at the center for the purpose of delivering the findings of the allegations 2 made regarding this child care center. The investigation consisted in interviews with the complainant, Directors 3 Ray and Mary Welch, and staff persons. Staff persons admitted that a child had become upset with their 4 efforts to potty train them . Eyewitnesses stated that a child was left on a potty chair for approximately 30 5 minutes. Also, staff admits that urine was not emptied every time a child used a potty chair. Regulation states 6 that the potty chair must be emptied every time it is used. Finally, a volunteer had been present at the school. 7 This person had been allowed to relieve employees for their breaks. Volunteers can be used in a child care 8 center, but they are not part of the staffing plan for the care and supervision of children.Based on the 9 statements obtained through the investigation, LPA finds there is evidence to support the above allegation. 10 Therefore, the allegation is substantiated. See LIC 9099D for deficiency cited under Manual of Policies and 11 Procedures Child Care Center, Title 22, Division 12, Chapter 1. A review of staff records on 2/2109 indicates 12 that all facility staff or other individuals who require caregiver background checks have received criminal record 13 and child abuse index dearances or exemptions.Notice of Site Visit is posted. Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2009 I acknowledge receipt of this fonn and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/0212009 C trol NL mb~::• C ' ILJ~ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE.A-230 ROHNERT PARK, CA M928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number TypeS 02/0212009 Section Cited 101223(a)(3) TypeS 02/02/2009 Section Cited 101428(e)(2) TypeS 02/0212009 Section Cited 101216(c) FACILITY NUMBER: 283005477 VISIT DATE: 02/0212009 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 Personal Rights-Children are to be free from 2 intimidation, ridicule, .. . threat, or other actions of a 3 punitive nature which interferes with functions of 4 daily living including eating, sleeping or toileting. 5 Child kept on a potty chair for an amount of time 6 which resulted in them crying and becoming upset. 1 Staff will be trained and sign a statement of this 2 training. A written plan of correction will be sent to 3 CCL by 2/9/09. 4 5 6 7 7 1 Infant Care Personal Services-After each use, the 2 potty chair shall be promptly emptied into a flushing 3 toilet, and all surfaces shall be thoroughly cleaned 4 and disinfected. 1 Staff will be trained as to the regulation and follow 2 the regulation. 5 6 7 1 Personnel Requirements-The licensee may utilize 2 volunteers provided that such volunteers are 3 supervised and are not included in the center's 4 staffing plan. A volunteer was used as a staff 5 person to allow employees to take breaks. 3 4 5 6 7 1 We will review the regulation and follow it. 2 3 4 5 6 7 6 1 2 1 2 3 4 5 3 4 5 6 7 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2009 LIC9099 (FAS) - (06104) Page: 2 of 2 STATE OF CAUFORNIA ·HEALnt AND HUMAN SERVICES AGENCY CAUFORHIA DEPARTliENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 84928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL FACILITY NUMBER: ADMINISTRATOR: WELCH, MARY FACILITY TYPE: ADDRESS: 1078 EAST AVENUE TELEPHONE: CITY: NAPA STATE:CA ZIP CODE: CAPACITY: 45 CENSUS: 51 DATE: UNANNOUNCED TIME BEGAN: Case Management TYPE OF VISIT: MET WITH: Ray Welch TIME COMPLETED: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 283005477 850 (707} 224-3825 94559 01/28/2009 02:30PM 03:40PM NARRATIVE A case management visit was conducted today. Children are observed in the playground, having lunch, and during nap time. Along with the directors, Ray and Mary Welch, there are six staff persons providing care and supervision. The facility is toured inside and out. See 8090 for deficiencies cited during today's visit. A Civil Penalty is assessed for a repeat violation within 12 months of the last violation .. Upon receipt of the licensing report, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months (LIC 9224). Failure to comply with this requirement shall be a violation of HSC section 1596.8595(c). Removal of any posted documents before 30 days is a $100.00 civil penalty violation. Shaken Baby Syndrome Brochure is given. Notice of Site Visit is posted. 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Unda Walker TELEPHONE: (707} 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2009 I acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC809 (FAS) • (06104) Page: 1 of2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE.A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 01/29/2009 Section Cited 101161 CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY NUMBER: 283005477 VISIT DATE: 01/28/2009 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 The number of children will not exceed 45 children . 2 The capacity of children in care will be reduced by 3 tomorrow, January 29, 2009. 4 5 6 7 1 2 3 4 5 6 7 Limitations on Capacity-A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This facility is licensed for 45 children. There are 10 toddlers and 41 preschool children in care for a total of 51 children . 8 9 10 11 12 13 14 A civil penalty of $150.00 is assessed for a second 8 violation within 12 months of the last violation. This 9 10 facility was cited on 4/3/08 for exceeding the 11 capacity of the license. 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2009 I acknowledge receipt of this fonn and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2009 This Notice must be posted for 30 days LIC809 (FAS) - (06/04) Page: 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 45 CENSUS: 51 UNANNOUNCED TYPE OF VISIT: POC MET WITH: Ray Welch 1 2 3 4 5 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 01/28/2009 10:25 AM 02:30PM NARRATIVE A plan of correction visit was conducted today . This facility was cited on 1/14/09 with deficiencies in the areas of Buildings & Grounds and Fixtures & Furniture . The center was found to have carpets that are dirty and stained and baseboards in the buildings which have accumulated dirt. These items were to have been cleaned by today, 1/28/09. These corrections have not been made which results in Civil penalties being assessed 6 7 8 9 10 11 12 13 14 15 Other deficiencies were cited and the corrections were observed today . These include: -Microwaves the kitchen and auditorium has been cleaned -Refrigerator in the kitchen and auditorium has been cleaned -Shelves where food is stored have been cleaned -Light fixtures in the au<;litorium have been replaced with new fixtures -Toilet paper is available in the children's bathrooms -Holes in the auditorium bathroom walls have been repaired -Laundry room is inaccessible to children . Both doors have hook and eye locks. -Outdoor changing table was dismantled and removed during today's visit. 16 17 18 19 20 21 22 23 24 25 A review of staff records on 1/28/09 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Shaken Baby Syndrome Brochure is given . Notice of Site Visit is posted . See 8090 for deficiencies cited today. SUPERVISOR'S NAME: Linda Walker TELEPHONE : (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: ~~ DATE: 01/28/2009 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) Pago : 1 of 2 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 02/02/2009 Section Cited 101238(a)(1) Type B 01/30/2009 Section Cited 101439(h)(4) Type B 01/28/2009 Section Cited 101227(8) FACILITY NUMBER: 283005477 VISIT DATE: 01/28/2009 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 Buildings and Grounds-Carpets are dirty and 2 stained . 3 4 $50.00 Civil Penalty is assessed 5 1 Carpets will be cleaned by 2/2/09. 2 3 4 5 6 6 7 7 1 Fixtures and furn iture-Outdoor chang ing table is not 1 Table is removed during th is visit. 2 within an arm's length of a sink. 2 3 3 4 4 5 5 6 6 7 7 1 2 3 4 5 Food service-All foods shall be selected , transpo rted , stored , prepared and served so as to be free from contamination and spoilage and shall be fit for human consumption . Plastic bags storing snack food are not comp letely sealed . 1 Bags we re comp letely closed during the visit. 2 3 4 5 6 6 7 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2009 LIC809 (FAS) • (06/04) Page: 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTTAGE - PRESCHOOL ADMIN ISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 45 CENSUS: 28 UNANNOUNCED TYPE OF VISIT: Case Management Ray and Mary Welch MET WITH : 1 2 3 4 5 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 01/14/2009 04:15PM 05:00PM NARRATIVE A case management visit was conducted today. LPM Linda Walker is also present during this visit. The facility was toured inside and out. Children are observed napping and engaged in individual play. Violations were identified regard ing bu ildings and grounds and fingerprint transfer requests . See LIC8090 for deficiencies cited during today's visit. 6 7 Notice of Site Visit is posted. Never Shake a Baby pamphlet is given . 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this f orm and understand my licensing appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: ~~!1~ DATE: 01/14/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC809 (FAS) • (06/04) Page: 1 of 3 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number DEFICIENCIES FACILITY NUMBER: 283005477 VISIT DATE: 01/14/2009 PLAN OF CORRECTIONS(POCs) Type B 01/15/2009 Section Cited 101170 1 2 3 4 5 6 7 Fingerpri(lt Clearances-Staff person Christine Gonzalez.is not associated to this facility. She is associated to Children's Cottage on Lincoln Avenue in Napa. The deficiency is cited by no Civil Penalty is assessed . 1 Fingerprint Transfer Request was completed by 2 Director during visit and mailed today. 3 4 5 6 7 Type B 01/14/2009 Section Cited 101238(a) 1 2 3 4 5 6 7 Buildings and Grounds-Center shall be safe at all times . Toxins were observed to be accessible in both playgrounds . The storage cabinets were unlocked. Lysol, Bacitracin , and Sun Screen products were accessible. 1 Cabinet was locked during visit. 2 3 4 5 6 7 Type B 01/14/2009 Section Cited 101238(a) 1 2 3 4 5 6 7 Buildings and Grounds-Center shall be safe at all times . Metal rods are exposed in the older ch ildren's playground . These rods present a hazard . 1 During the visit, the metal rods were pounded down 2 so that children would not trip. 3 4 5 6 7 Type B 01/28/2009 Section Cited 101238(a) 1 2 3 4 5 6 7 Buildings and Grounds-Center will be kept in good repair. There is a hole in the wall, where the door knob hits the wall, in the girl's bathroom . The bathroom is located in the auditorium room . 1 The hole will be repa ired by 1/28/09. 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2009 LIC809 (FAS) • (06/04) Page : 2 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 01 /28/2009 Section Cited 101238(c) FACILITY NUMBER: 283005477 VISIT DATE: 01/14/2009 DEFICIENCIES 1 2 3 4 5 6 Buildings and Grounds-laundry room is accessible to children in care. The room is accessible by two doors. Only one door had a hook and eye lock on the door.. The other door can be opened . PLAN OF CORRECTIONS(POCs) 1 A lock will be installed by 1/28/09. 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this f orm and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2009 LIC809 (FAS) • (06/04) Pago : 3 of 3 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE ST£.A·230 ROHNERT PARK, CA 94928 oR This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/10/2008 and conducted by Evaluator Iris Hidalgo PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20080910103919 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL ADMINISTRATOR: WELCH, MARY ADDRESS: 1078 EAST AVENUE STATE: NAPA CITY: CENSUS: 28 CAPACITY: 45 MET WITH: Ray and Mary Welch 283005477 850 (707) 224-3825 94559 01/1412009 02:20PM 05:45PM ALLEGATION(S): 1 -Violation of Physical Plant guidelines-facility is filthy. Staff has found rodent droppings and bug larvae in areas 2 used by children. 3 -Violation of Personal Rights-Children are using a potty chair outside in the playground in full view of other 4 children . 5 6 7 8 9 INVESTI ATION FINDIN S: 1 Investigation consisted of interview with the complainant and Ray and Mary Welch. Also, photographs were 2 taken of the facility on 9122/08, showing the areas used by children in care. Photos taken support the 3 allegation that the facility is dirty. (Specific areas identified on LIC9099 D). 4 Photos show potty chairs, in the playground, positioned next to the fence. The chairs are in full view of anyone 5 in the yard. The chairs are in the play space and therefore do not allow children to have dignity when toileting. 6 Based on the statements and information obtained through the investigation, LPA finds there is evidence to 7 support the above allegations. Therefore, the allegations are substantiated. 8 See LIC 9099D for deficiencies cited under Manual of Policies and Procedures Child Care Center , Title 22, 9 Division 12, Chapter 1. 10 11 Notice of Site Visit is posted. Never Shake a Baby Pamphlet is given. 12 13 Estimated Days of Completion: Substantiated SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this fonn and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/1412009 This report must be available at Child Care and Group Home facilities for public review for 3 years. Control urnbt>r 1 1 00' 0 I STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number 2 1) Kitchen area: microwave is dirty inside and out, 3 bags of snack foods open and exposed, a towel, 4 wet with rusted water on the bottom shelf of the 5 refrigerator, shelves and compartments are dirty. 6 Shelves where food is stored are dirty. 2) 7 Auditorium area: microwave is 8 9 10 11 12 13 14 TypeS 01/28/2009 Section Cited 101223(a)(1) PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 Buildings and Grounds-photos show: Type 8 01/2812009 Section Cited 101238(a)(1) FACILITY NUMBER: 283005477 VISIT DATE: 01/14/2009 microwave is dirty with baked on food, refrigerator is dirty, refrigerator gaskets are dark with grime, suspended light fixtures have accumulated dirt which is easily seen, and the rugs are stained. 3) Bathroom in auditorium is lacking toilet paper, walls have holes, baseboards have accumulated dirt. 1 The facility will be cleaned by 1/28/09. A plan for 2 regular maintenance will be set up and submitted 3 to CCL. 4 5 6 7 8 9 10 11 12 13 14 1 Personal Rights-Children not given dignity in 2 his/her personal relationships with staff and other 3 persons. Children are using potty chairs in area 4 were children are playing. 1 Will submit a plan of correction to address this 2 issue. Will submit plan to CCL by 1/28/09 to 3 provide a space in the playground which provides 4 more privacy. 5 6 7 5 6 7 1 2 1 2 3 3 4 4 5 6 7 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01114/2009 LIC9099 (FAS) - (06/CM) Page: 2 Of2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 01/07/2009 and conducted by Evaluator Iris Hidalgo PUBLIC COMPLAINT CONTROL NUMBER: 01 -CC-20090107163741 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR: WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: 45 CENSUS: 28 CAPACITY: MET WITH: Ray and Mary Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 01/14/2009 02:20PM 04:00PM ALLEGATION(S): 1 -Physical Plant-carpets are not clean 2 -Outside changing table not next to sink 3 4 5 6 7 8 9 INVESTIGA ION FINDINGS: 1 An initial 10 day visit was conducted today to this facility. LPM Linda Walker is also present during this visit. 2 The investigation consisted of an inspection of the physical plant. The facility is toured inside and out. The 3 carpets are stained and dirty in throughout the facility . There is an outdoor changing table, located on the 4 ramp alongside the building, which is not within an arm length of a sink. Based on the observations seen 5 today, LPA finds there is evidence to support the above allegation. Therefore, the allegation is substantiated. 6 7 See LIC 90990 for deficiency cited under Manual of Policies and Procedures Child Care Center . Title 22, 8 Division 12, Chapter 1. 9 10 Notice of Site Visit is posted. Never Shake a Baby pamphlet is given. 11 12 13 Estimated Days of Completion: Substantiated SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. Control Number ') - Lli0' r H f ' STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE OR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number TypeS 01/28/2009 Section Cited 101238(a) Type 8 01/15/2009 Section Cited 101439(h)(4) FACILITY NUMBER: 283005477 VISIT DATE: 01/14/2009 DEFICIENCIES 1 2 3 4 5 Buildings and Grounds-The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. The carpets are dirty and stained. PLAN OF CORRECTIONS(POCs) 1 The rugs will be cleaned by 1/28/08 and self 2 certification that it was done will be sent to CCL. 3 4 5 6 7 6 7 1 Fixtures and Furniture-outdoor changing table is 2 not within an arm's length of a sink. 3 4 5 1 Table will be removed by 1/15/09. 2 3 4 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2009 UC9099 (FAS) • (06104) Page: 2 of2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 COMPLAINT INVESTIGATION REPORT This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/10/2008 and conducted by Eva luator Iris Hidalgo PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-2008091 0103919 FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE STATE: CITY: NAPA 45 CENSUS: 22 CAPACITY: UNANNOUNCED MET WITH: Ray and Mary Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 09/22/2008 09:40AM 04:40PM ALLEGATION(S): 1 Record keeping-Children's files are not in substantial compliance 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 THIS IS AN AM MENDED DOCUMENT REGARDING THE VISIT OF 9/22/08 2 An initial10 day visit was conducted today for the purpose of investigating the above allegation. Investigation 3 consisted of interview with complainant and review of children's files. Ten children's files are randomly 4 selected . Missing from their files are a variety of forms which include Medical Consent, Immunization 5 Information , Parents' Preadmission Health Histories, Physician Reports , Admission Agreements , and 6 Identification and Emergency Information . Each child had at least one form not available in their files . See 7 9099D for deficiencies cited during today's visit. Based on the statements and evidence obtained through the 8 investigation , LPA finds there is evidence to support the above allegation . Therefore , the allegation is 9 substantiated. Upon receipt of the licensing report, licensee shall post and provide copies of this licensing 10 report to parents/guardians of child ren in care at the facility and to parents/guardians of children newly enrolled 11 at the facility during the next 12 months (LIC 9224) . Failure to comply with this requirement shall be a violation 12 of HSC section 1596.8595(c) . Removal of any posted documents before 30 days is a $100.00 civil penalty 13 violation . Shaken Baby Syndrome Brochure is given . Notice of Site Visit is posted . Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 Control Number 01-CC-2008091 0103919 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NUMBER: 283005477 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number VISIT DATE: 09/22/2008 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type B 10/06/2008 Section Cited 101220.1 1 Immunizations-Immunization information is missing 1 Immunization information will be requested from 2 or incomplete for child #2, #6, and #7. 2 the parents and available in the child's file by 3 10/6/08. 3 4 4 5 5 6 6 7 7 Type B 10/06/2008 Section Cited 101221(8) 1 Parents will be given forms to complete and these 1 Childs's Records-Parent's Report of a Child's 2 Preadmission Health History is missing for chid #4, 2 forms will be made ava ilable in the child's file by 3 10/6/08. 3 #5, #7 , and #8. 4 4 5 5 6 6 7 7 Type B 10/06/2008 Section Cited 101220(a) 1 2 3 4 5 6 7 Type B 09/23/2008 Section Cited 101219(a) 1 Admission agreement-admission agreement 2 missing for ch ild #9 3 4 5 6 7 Child's Medical Assessment-Prior to, or within 30 calendar days following the enrollment of a child , the licensee shall obtain a written medical assessment of the child . Child #6 and #8 have been enrolled over 30 days. This document is not available in theire file . 1 2 3 4 5 6 7 Parents will be instructed to have medical check ups for their children as soon as possible. If the child's medical check up can not be completed by 10/6/08 an appointment date will be subm itted to CCL as to when the child is expected to be seen by their doctor. 1 Parent will be given an admission agreement to 2 sign today, 9/2 2/08. 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: f/2cw! f!lt~ LIC9099 (FAS) • (06/04) DATE: 09/22/2008 Page : 2 of 5 Control Number 01-CC-20080910103919 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) Redwood Empire CC, 101 Golf Cours e Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2008 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 10/24/2008 Section Cited 101218.1(e)(1 ) DEFICIENCIES 1 2 3 4 5 6 7 ADM ISSION PROCEDURES AND PARENTAL AND AUTHORIZED REPRESENTATIVE'S RIGHTS-Parent's Rights Receipt is not in the fi le of child #10. PLAN OF CORRECTIONS(POCs) 1 Parent will be given Parent's rights form to sign . 2 receipt will be placed in the child's file by 10/24/08. 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 LIC9099 (FAS) • (06/04) Page : 3 of 5 !! Control Number 01 -CC-2008091 01 03919 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont) Rohnert Park, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number DEFICIENCIES 1 child's Records-Medical consent missing for child :rype 8- - - i )~ #7 09L2312eaaSection Cited 5 101221(b)(8)(C} 6 7 ! - TypeB o9t23t2ooa Section Cited 101221(a) FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2008 PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 Child is in care today. Parent will be given form and it will be signed when they pick up their child. LIC 9098 Proof of Corrections will be used to verify corrections Child's Records-Separate, complete, and current record must be kept for each child. This 3 information is missing for child #8. 4 5 6 7 1 Parent will be given form and it will be signed when 2 they pick up the sibling of child #8. 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 I~2 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: ~· DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 LIC9099 (FAS) • (06104) Page: 4 ot 5 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA 45 CAPACITY: CENSUS: 22 UNANNOUNCED Case Management - Other TYPE OF VISIT: Ray and Mary Welch MET WITH: 1 2 3 4 5 6 7 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NUMBER: FACILITY TYPE : TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 09/22/2008 05:03PM 06:00PM NARRATIVE THIS DOCUMENT IS AN AMENDMENT FOR THE VISIT OF 9/22/08 A case management visit was conducted today. When the visit began, neither Director Ray Welch or Administrator Mary Welch were at the Center. Teacher, Julia Padilla was the staff person in charge. Mr. and Mrs. Welch arrived at the center approximately 10 minutes after the visit began . Teacher Julia Padilla is caring for 6 preschoolers, teacher Susana Reyes is caring for 6 todd lers, and teacher Lisa Crane is caring for 10 preschoolers . Sign In and Sign Out sheets verify the census . Staff and children's records are reviewed . 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 See LIC 899D for deficiences cited during today's visit. Upon receipt of the licensing report , licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facil ity during the next 12 months (LIC 9224) . Failure to comply with this requirement shall be a violation of HSC section 1596.8595(c). Removal of any posted documents before 30 days is a $100.00 civil penalty violation . Shaken Baby Syndrome Brochure is given. Notice of Site Visit is posted . SUPERVISOR'S NAME: Carl Hockett TELEPHONE : (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE : DATE: 09/22/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) Page: 1 of 2 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUN ITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Par1<, CA 94928 FACILITY EVALUATION REPORT (Cont) FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2008 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 09/23/2008 Section Cited 101212(d)(1)(C) Type A 09/22/2008 Section Cited 101223(a)(3) Type B 09/23/2008 Section Cited 101216(g)(3)(B) Type B 09/23/2008 Section Cited 101216(g)(3)(A) DEFICIENCIES 1 2 3 4 PLAN OF CORRECTIONS(POCs) Reporting Requirements-a child in care had a biting incident which left teeth marks on another child , and another incident where they broke the skin on a child . This behavior threatens the physical and 5 emotional heal of the bitten child and needs to be 6 reported to CCL 7 1 Biting incidents where there is injury to a child will 2 be reported to CCL within 24 hours and a written 3 report within 7 days. 4 1 2 3 4 Personal Rights Children are to be free from infliction of pain . A child has bitten ch ildren th ree times. The injury resulted in teeth marks and broken skin. 1 2 3 4 Personnel Requirements-Volunteers are required to have a TB clearance. A volunteer at th is center has been working without a TB clearance . This information is not available in their file . 1 Volunteer will not be allowed to work until they have 2 TB results . 3 4 5 6 7 1 2 3 4 5 6 7 The child will be watched more closely. The child will be shadowed . Staff will try to catch the ch ild being good , use brief time outs . Parents are notified of their child 's behavior. Literature is given 5 to the parents of the child who bites . Limits will be 6 set when they are playing . 7 5 5 6 7 6 7 1 2 3 4 Personnel Requirements-Volunteers need to subm it a statement that they are in good health. This information is not available in the file of a volunteer. 1 Volunteer will provide a statement of good health in 2 order to work at the center. 3 4 5 5 6 7 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME : Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: -/h.~ DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 This Notice must be posted for 30 days LIC809 (FAS) • (06104) Page : 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Sto. A230 Rohnert Park, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/10/2008 and conducted by Evaluator Iris Hidalgo PUBLIC COMPLAINT CONTROL NUMBER: 01 -CC-20080910103919 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE STATE: CITY: NAPA CENSUS: 22 CAPACITY: 45 UNANNOUNCED Ray and Mary Welch MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 09/22/2008 09:40AM 04:40PM ALLEGATION(S): 1 Record keeping-Children's files are not in substantial compliance 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 THIS IS AN AMMENDED DOCUMENT REGARDING THE VISIT OF 9/22/08 2 An initial 10 day visit was conducted today for the purpose of investigating the above allegation . Investigation 3 consisted of interview with complainant and review of children's files . Ten children's files are randomly 4 selected. Missing from their files are a variety of forms which include Medical Consent, Immunization 5 Information , Parents' Preadm ission Health Histories , Physician Reports , Admission Agreements , and 6 Identification and Emergency Information . Each child had at least one form not available in their files . See 7 9099D for deficiencies cited during today's visit. Based on the statements and evidence obtained through the 8 investigation , LPA finds there is evidence to support the above allegation . Therefore , the allegation is 9 substantiated . Upon receipt of the licensing report, licensee shall post and provide copies of this licensing 10 report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled 11 at the facility during the next 12 months (LIC 9224). Failure to comply with this requirement shall be a violation 12 of HSC section 1596.8595(c). Removal of any posted documents before 30 days is a $100 .00 civil penalty 13 violation . Shaken Baby Syndrome Brochure is given . Notice of Site Visit is posted . Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC9099 (FAS) • (06/04) Page : 1 of 5 Control Number 01-CC-2008091 0103919 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Pari<, CA 94928 FACILITY NUMBER: 283005477 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number VISIT DATE: 09/22/2008 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type B 10/06/2008 Section Cited 101220.1 1 Immunizations-Immunization information is missing 1 Immunization information will be requested from 2 the parents and available in the child's file by 2 or incomplete for child #2 , #$, and #7. 3 10/6/08. 3 4 4 5 5 6 6 7 7 Type B 10/06/2008 Section Cited 101221(8) 1 Parents will be given forms to complete and these 1 Childs's Records-Parent's Report of a Child's 2 Preadmission Health History is missing for chid #4, 2 forms will be made available in the child's file by 3 10/6/08. 3 #5, #7, and #8. 4 4 5 5 6 6 7 7 Type B 10/06/2008 Section Cited 101220(a) 1 2 3 4 5 6 7 Type B 09/23/2008 Section Cited 101219(a) 1 Adm ission agreement-admission agreement 2 missing for child #9 3 4 5 6 7 Child's Medical Assessment-Prior to, or within 30 calendar days following the enrollment of a child , the licensee shall obtain a written medical assessment of the child . Child #6 and #8 have been enrolled over 30 days. This document is not available in theire file . 1 2 3 4 5 6 7 Parents will be instructed to have medical check ups for their children as soon as possible. If the child's medical check up can not be completed by 10/6/08 an appointment date will be subm itted to CCL as to when the child is expected to be seen by their doctor. 1 Parent will be given an admission agreement to 2 sign today, 9/22/08. 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: f/2cw; Mt~ LIC9099 (FAS) • (06/04) DATE: 09/22/2008 Page : 2 of 5 Control Number 01 -CC-2008091 0103919 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 10/24/2008 Section Cited 101218.1(e)(1) FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2008 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 1 Parent will be given Parent's rights form to sign . ADMISSION PROCEDURES AND PARENTAL 2 receipt will be placed in the child's file by 10/24/08. AND AUTHORIZED REPRESENTATIVE'S RIGHTS-Parent's Rights Receipt is not in the file of 3 child #10. 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME : Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2008 1acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 LIC9099 (FAS) • (06/04) Page: 3 of 5 Control Number 01 -CC-2008091 0103919 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 COMPLAINT INVESTIGATION REPORT (Cont) FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number FACILITY NUMBER: 283005477 VISIT DATE: 09/22/2008 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type B 09/23/2008 Section Cited 101221 (b)(8)(C) 1 child's Records-Medical consent miss ing for child 2 #7 3 4 5 6 7 1 2 3 4 5 6 7 Type B 09/23/2008 Section Cited 101221(a) 1 Child's Records-Seperate, complete , and current 2 record must be kept fo r each child. This 3 information is missing for child #8. 4 5 6 7 1 Parent will be given form and it will be signed when 2 they pick up the sibling of child #8. 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Child is in care today. Parent will be given fonm and it will be signed when they pick up their ch ild. LIC 9098 Proof of Corrections will be used to verify corrections Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE : (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: ~- DATE: 09/22/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2008 LIC9099 (FAS) • (06/04) Page : 4 of 5 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 This is an official report of an unannounced vis it/investigation of a complaint received in our office on 08/07/2008 and conducted by Evaluator Iris Hidalgo COMPLAINT CONTROL NUMBER: 01-CC-20080807152550 FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL ADMINISTRATOR:WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 45 CENSUS: 29 UNANNOUNCED Mary Welch , Administrator MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/18/2008 11:45 AM 05 :55PM ALLEGATION(S): 1 -Lack of Supervision-Direct supervision of a child was not maintained by staff 2 -Classroom door which opens to the playground does not work properly. 3 -Unusual Incident was not reported to Licensing 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Investigation consisted of interviews with the complainant, staff persons, and administrator. An incident 2 occurred whereby an child wandered away from staff person and their whereabouts were not known. A parent 3 arrived at the school and found their child walking through a doorway which leads to an outside walkway . Mrs. 4 Welch and staff persons admit the incident happened when a parent left the building and a door was not closed 5 behind them . Staff persons state persons entering and leaving the preschool often do not check to make sure 6 doors and gates are completely closed. The door from the Toddler Classroom to the playground does not shut 7 properly. The door knob does not latch onto the frame piece. Based on the statements obtained through the 8 investigation , LPA finds there is evidence to support the above allegations. The allegation is substantiated . 9 See LIC 9099 for deficiency cited under Manual of Policies and Procedures Child Care Center, Title 22, 10 Division 12, Chapter 1.Upon receipt of the licensing report, licensee shall post and provide copies of this 11 licensing report to parents/guardians of children in care at the facility and to parents/guardians of children 12 newly enrolled at the facility during the next 12 months (LIC 9224) . Failure to comply with this requirement 13 shall be a violation of HSC section 1596.8595(c). Removal of any posted documents before 30 days is a $100.00 civil penalty violation . Shaken Baby pamphlet given . Shaken Baby Syndrome Brochure is given . Notice of Site Visit is posted . Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Pogo : 1 of 3 Control Number 01-CC-20080807152550 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Pari<, CA 94928 FACILITY NUMBER: 283005477 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 08/18/2008 Section Cited 101229(a) DEFICIENCIES 1 2 3 4 5 6 Care and supervision-The licensee shall provide care and supervision as necessary to meet the children's needs. A child wandered away and their whereabouts were not known by staff.. 1 2 3 4 5 6 PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 Signs have been posted on all of the gates and doors to remind persons entering and exiting to close doors and gates. Staff have been instructed to check doors and gates often . Also , parents are reminded to close gates and doors. 7 7 Type A 08/19/2008 Section Cited 101238 VISIT DATE: 08/18/2008 Buildings and Grounds-CCC shall be in good repair at all times. Door from Toddler Room to playground does not close properly. The door knob does not latch onto the door frame. 1 The door was repaired during th is visit. The door 2 closes easily and latches. 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE : 08/18/2008 This Notice must be posted for 30 days LIC9099 (FAS) • (06/04) Page: 2 of 3 Control Number 01 -CC-20080807152550 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Pori<, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 08/22/2008 Section Cited 101212(d)(1)(C) FACILITY NUMBER: 283005477 VISIT DATE: 08/18/2008 DEFICIENCIES Reporting Requ irements-Unusual Incident report 1 not submitted to CCL to report the absence of a 2 child from supervision .. 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) 1 A report shall be made to CCL by telephone or fax 2 within the Department's next working day and 3 during its normal business hours . In addition , a 4 written report containing the information shall be 5 submitted to CCL within seven days following the 6 event. A report will be sent regarding the June incident. 7 1 2 1 2 3 3 4 4 5 6 7 5 6 7 1 2 1 2 3 3 4 4 5 6 7 5 6 7 1 2 1 2 3 3 4 4 5 6 7 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE : (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291 -8907 LICENSING EVALUATOR SIGNATURE: ~~ DATE: 08/18/2008 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2008 LIC9099 (FAS) • (06/04) Page : 3 of 3 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Pari<, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 45 CENSUS: 29 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Mary Welch, Administrator 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/18/2008 11 :45AM 06:15PM NARRATIVE A case management visit was conducted because the licensee wishes to increase the capacity of the preschool to 95 children. The preschool will now add the auditorium space located across from the office. Various areas of the center are inspected. The school consists of Preschool classrooms 1, 3, the auditorium space, and classroom 2 (toddler option). Classrooms have furniture and equipment that is age appropriate. Heating, lighting, and ventilation is adequate. Drinking water is readily available using cups and a water pitcher. There is adequate storage for the children's belongings. There is 35 square feet of indoor space per child based on the total licensed capacity. The office will be used as an isolation area for the care of an ill child . Bathrooms and toileting areas meet guide lines for the number of children in care. There are 7 toilets and 9 hand washing sinks. Toilets flush and faucets work. Only cold water is used for hand washing by the children. Toilet paper and towels are available to meet the children's needs. Food preparation area is inaccessible to children. Cleaning supplies are inaccessible children and are stored separately from food . Breakfast and lunches are provided by parents. Center provides snacks. The play area is inspected. There is 75 square feet per child based upon licensed capacity. Climbing structure is securely anchored. The cushioning material is shredded bark Drinking water is provided by cups and a pitcher. Shade is provided by trees, a covered sand box and a wooden awning. Fencing is at least four feet high around the perimeter of the playground. Sandbox is free of hazardous materials. For napping, cots and mats are available for each child in care. Bedding and mats are stored properly. There is a working telephone on the premises. First aid supplies will be kept in each classroom. At least 1 staff person present has current pediatric first aid/CPR cards. Required forms are posted. PUB 271 (Never Shake a Baby) is given. LIS staff records on 8/18/08 indicates that facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee is requesting to share outdoor play space between the preschool age children and the toddler group. A waiver request is submitted. Center is currently approved for 45 children. The increase in capacity is being reviewed. See 809D for deficiencies cited during this visit. Upon receipt of the licensing report, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months (LIC 9224). Failure to comply with this requirement shall be a violation of HSC section 1596.8595(c). Removal of any posted documents before 30 days is a $100.00 civil penalty violation . SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2008 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2008 f This report must be available at Child Care and Group Home facilities for public review for 3 years. -- HEALTH AND HUMAN senvnces AGENCY W-N-rm sou-tsemss couumm uni Iwuox FACILITY EVALUATION REPORT (Cont) an-om w. n-.mo m. un- FACILITY NAME: COTTAGE - PRESCHOOL Nuugglg; 233095477 nencneucv mroauumou son mus PAGE: vlsn' DA1E:oaI1ar2uoI3 noflcluncy F00 um um! DEFICIENCIES PLAN OF socuou Numbvr Cnminll Record clamnae Teacher! Fnnqetpnm Iranavar submmad today 1 Type A 2 and -- do-ranoes wnmooa 3 assocmea In cnuum-'5 Cuttaga on Lincoln Ave Sm," CM, I Translev is mquestod Deflcuency am am Cum 5 'ammo 6 penalty nullsuued 7 I Fmmaa um supptesmmemu shill be me ol lock insxauea an an: czhmel and a pamouk A 2 um: substances sun (In lallun (wwth Izbel on om: unmet uwaunng awmwa 3 maxmamg pmuun be kept out at much cm or-man) Iogawbla In children vmauas kept In 01 5 outdoor cabinets any way latch 7 lulu to correctme clted on or bofom the Plan Mcorroctlon (P06) one data, may mum in . cm: penalty aueasmem. suPERvIsoR's NAME: can Hocken YELEPHONE: (707) 5856055 LICENSING EVALUATOR NAME: Ins Hldalgo YELEPHONE: (m7) 291-E907 LICENSING EVALUATOR SIGNATURE: 1 one: oansrzuoa I acknowledge mcelpl 01 this form and undumand my appeal rights as explained and reealved. FACILITV REPRESENTAYIVE SIGNATURE: WW MW DATE: 0511 a/zoos 'min Naflce must be posted lot so days ucaooIrA.ay.(mm4y STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 45 CENSUS: 32 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Mary Welch , Administrator 1 2 3 4 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMS10N Redwood ~nt CC, 101 Golf Course Dr. Ste. A230 Rohnert Part<, CA 94928 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 06123/2008 01:40PM 02:30PM NARRATIVE A case management visit was done today for the purpose of determining the space used by this preschool. Ms. Welch is requesting to increase the capacity of the preschool to 95 children. Now that the school age children are using the 1098 East Avenue site, the auditorium space will be used exclusively by the preschol children . 5 6 7 8 Twelve children are under the supervision of teachers Julia Padilla and Rhonda Nelson in room #1 , eleven toddlers are under the care of teacher Susanna Reyes and aide Veronica Shroyer in room 2, and nine children are being supervised by teacher Collen Weitz in room #3. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 The facility is toured inside and out. No deficiencies are cited today Notice of Site Visit is posted. Never Shake a Baby is given .. . SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 291-8907 LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2008 I acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06123/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06104) Page: 1 of 1 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT FACILITY NAME: CHILDREN 'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE NAPA CITY: STATE:CA 45 CAPACITY: CENSUS: 53 UNANNOUNCED TYPE OF VISIT: Annual/Random Mary Welch MET WITH: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 04/03/2008 10:30 AM 01 :30PM NARRATIVE LPA Barbara Lawler conducted an annual site visit and inspected for health , safety, and Title 22 compliance . LPA initially met with lead teachers , Pilar, Susana , Lisa , Sarah and Rueann . Licensee , Mary Welch arrived during the visit. This is a combination center, with toddler component, preschool, and school age programs. LPA toured all classrooms and observed teacher ch ild ratios. Ladybugs 2's 2 teachers were caring for 15 two year olds during lunchtime. Caterpillars toddlers- 2 teachers supervising 8 toddlers Bumblebees 3-4's 2 teachers supervising 21 children Dragonflies pre-K 1 teacher supervising 9 children Butterflies pre-K 1 teacher supervising 11 ch ildren LPA reviewed sign in and out sheets used for children and sign it sheets for staff. LPA reviewed staff files for early childhood education transcripts. LPA inspected all classrooms and outdoor play areas . LPA observed ch ildren during outdoor play, lunch, and nap time . During nap time 26 preschool age children were under the care and supervision of two teachers . Ratios were exceeded during napping activity. One child needed the assistance of a teacher for toileting and another child became restless . Child who was moving about the classroom during nap time required the supervision of the teacher. The second teacher moved from one side of the classroom to sit with this child . Facility was closing at 5:30PM LPA discussed this report and deficiencies observed. A subsequent visit will be made. LPA DISCUSSED WITH LICENSEE: AB 633 FACT SHEET AND PARENTS ACKNOWLEDGMENT OF RECEIPT OF LICENSING REPORTS , APPEAL RIGHTS , RATIOS DURING NAPPING , AND VISUAL SUPERVISION OF CHILDREN IN CCC See following lie 809D for deficiencies: APPEAL RIGHTS DISCUSSED NOTICE OF SITE VISIT POSTED SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE : DATE: 04/03/2008 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2008 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC809 (FAS) • (06/04) Page : 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 04/03/2008 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 04/03/2008 Section Cited 101230 Type A 04/03/2008 Section Cited 101161 Type A 04/03/2008 Section Cited 101238 DEFICIENCIES 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) During nap time 25 preschool age children were under the supervision of two teachers. One teacher was attending to the child toileting and second teacher attending to the restless child . An additional staff was needed to maintain compliance with ratio. Ratio exceeded due to activity of awake children . 1 Licensee will complete plan of correction and mail 2 to licensing April 4 2008 3 4 5 6 7 1 License capacity exceeded. 57 preschool and 2 toddler age children in care. License capacity is 3 45. 4 5 6 7 1 Licensee will complete plan of correction and mail 2 to licensing April 4 2008 3 4 5 6 7 1 Disinfectants and toxins which state keep out of the 2 reach of children observed accessible to children in 3 several classrooms in facility 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2008 appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2008 This Notice must be posted for 30 days LIC809 (FAS) • (06/04) Page: 2 of 2 STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste. A230 Rohnert Par1<, CA 94928 COMPLAINT INVESTIGATION REPORT This is an official report of an unannounced visit/investigation of a complaint received in our office on 01/10/2006 and conducted by Evaluator Iris Hidalgo PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20060110144227 CHILDREN'S COTIAGE - PRESCHOOL FACILITY NAME: DIRECTOR: ADDRESS: CITY: WELCH, MARY 1078 EAST AVENUE NAPA STATE:CA FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: CAPACITY: 45 CENSUS: 62 DATE: 283005477 850 (707) 224-3825 94559 04/21/2006 UNANNOUNCED TIME VISIT MET WITH: Mary Welch , director BEGAN: TIME COMPLETED: 11 :40 AM 05:30PM ALLEGATION(S): 1 -Violation of teacher-child ratio. Too many children for the staff present in the facility. 2 -Commingling of children from different components 3 -exceeds license 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Investigation consisted of interviews with complainant and staff persons. During today's visit, 11 two year old 2 children are under the care of one staff person, 11 toddler age children are under the supervision of 2 staff 3 persons, 11 three year olds are under the supervision of one staff person, and 29 pre-kindergarten children are 4 under the supervision on 2 staff persons. Ray Welch is also present during this visit. Ms. Welch states that 5 three teachers are out ill. When the visit began, the children are starting their napping time. Today, this 6 facility does not exceed the staff to child ratio for the 12 toddlers. However, this facility is licensed for a total 7 of 45 preschool children . There are 11 toddlers, 22 children in the classroom space which is shared with the 8 toddlers and 29 children in the pre-kindergarten class next door. When combined, there are 62 children in 9 care. The preschool capacity of this facility is 45. Available evidence shows a pattern of exceeding teacher 10 child ratio and commingling ages. 11 12 The allegation is substantiated. See 9099 D for deficiencies cited. 13 Notice of Site Visit is posted. Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 588-5061 LICENSING EVALUATOR SIGNATURE:;_ __:::;;,c.~_::::.:=::~----- DATE: 04/21/2006 explained and received. FACILITY REPRESENTATIVE SIGNATURE:.:__-~~~~~.......:;.--- DATE: 04/21/2006 UC9099 (FAS) • (08104) Page: 1 af 2 5 vI)..,,.. I I Lf'v 1 Control Number 01-CC-2006011 0144227 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood EMpire CC, 101 Golf Course Dr. Ste. A230 Rohnert Park, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type VISIT DATE: 04121/2006 DEFICIENCIES POC Due Date I PLAN OF CORRECTIONS(POCs) Section Number Type A 0412412006 Section Cited 101216.3 1 2 3 4 5 6 7 Type A 1 0412412006 Section Cited 2 101238.2 TypeS 3 4 Teacher-Child ratio One teacher can visually supervise 12 children. Two teachers are supervising 29 children in the pre-kindergarten room. The children are resting, but are not asleep. 1 2 3 4 5 6 7 Commingling of ages is allowed during the first and last hour of the day for planned actiVities which are time limited. Available information indicates children are commingled on a regular basis at the convenience of the center. 1 2 3 5 4 5 6 6 7 7 1 3 4 Limitations on Capacity-A licensee shall not operate a child care 1 2 center beyond the conditions and limitations specified on the 3 license, including the capacity limitation. Facility is licensed for 4 45 preschool age children. 62 children are in care. 5 6 7 5 6 7 1 1 2 2 I had appropriate nap time ratio. 2 4 5 3 4 5 6 6 7 7 3 Irs not true. I disagree. I am not in violation Failure to correct the ctted deflciency(ies), on or before the Plan of Correction (POC) due date, may resutt in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 588-5061 LICENSING EVALUATOR SIGNATURE:_~f'-..;;_,;__-l'...__ _ _ __ DATE: 04!.2112006 LIC9099 (FAS)- (06104) Page: 2ot 2 STATE OF CAliFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAliFORNIA DePARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT Rohnert Par1t. CA 94928 FACILITY NAME: DIRECTOR: ADDRESS: CITY: Redwood Emptra CC, 101 Golf COUrM Dr. Sta. A230 CHILDREN'S COTTAGE- PRESCHOOL WELCH, MARY 1078 EAST AVENUE NAPA STATE:CA CAPACITY: 45 TYPE OF VISIT: Case Management Mary Welch, director MET WITH: CENSUS: 62 UNANNOUNCED DEFICIENCY INFORMATION FOR THIS PAGE: Type A FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: 283005477 850 (707) 224-3825 94559 DATE: TIME BEGAN: TIME COMPLETED: 0412112006 11 :40 AM 05:50PM CML PENALTY INFORMATION: Not Applicable COMMENTS/DEFICIENCIES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A case management visit is conducted today. This facility has a combination preschool/toddler component. Also present is Ray Welch. During today's visit, 11 two year old children are under the care of one staff person, 11 toddler age children are under the supervision of 2 staff persons, 11 three year olds are under the supervision of one staff person, and 29 pre-kindergarten children are under the supervision on 2 staff persons. Children are observed napping and trying to nap. Furniture and equipment is age appropriate. Heating, lighting, and ventilation is adequate. Drinking water is readily available both inside and outside. Bathrooms and toileting areas meet guide lines for the number of children in care. Toilets flush and faucets work. Toilet paper and towels are available. Hot water does not exceed 120 degrees. Only snacks are provided by the facility. Children provide their own lunches. Mats are available for each child under the age of 5 years. The preschool play area has climbing structures which are securely anchored. The toddler group has a separate play area. Both areas use shredded bark as a cushioning material. The sand boxes are free of hazardous materials. Shade is provided by a shade structure over the sand boxes and trees. Sign-in and sign-out sheets verify census. At least 1 staff person present has current pediatric first aid/CPR cards. Posting requirements which include license, parent's rights, and emergency disaster plan are met. First aid supplies are kept in the kitchen area . Medications are inaccessible in the kitchen area. An ill child is isolated in the office area. Fire extinguisher is charged. See 8090 for deficiencies cited during this visit Notice of Site Visit is posted 22 23 Failure to correct the cited deflclency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty anessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 588-5061 LICENSING EVALUATOR SIGNATURE:_~-#;.::t:A---L.::::!::::::~*--- DATE: 0412112006 ATE: 0412112006 LIC809 (FAS)- (01104) Page: 1 of2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICE$ AGENCY FACILITY EVALUATION REPORT (Cont) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, fOf Golf Course Dr. Ste. A230 Rohnert Park. CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 0412412006 Section Cited 101221 TypeS 0412812006 VISIT DATE: 04/21/2006 DEFICIENCIES 1 2 3 4 5 6 7 1 2 Section Cited 101238 3 4 5 6 7 TypeS 0412112006 Section Cited 101225 1 2 Children's Records-Record of current medications, including the name of the prescribing physician, and instructions, if any, regarding control and custody of medications. Information not available for two students. Medications not kept in original container. Buildings and Grounds-center shall be kept in good repari at all times. Gate which opens to the kitchen area is easilly opened. Cleaning solutions (Ciorox) is stored under the kitchen sink. Child passenger restraint is not posted. PLAN OF CORRECTIONS(POCs) 1 2 Medicatgions will be kept in the original container. 3 4 5 6 7 1 2 Will have a latch/closure installed on the gate. 3 4 5 6 7 1 2 3 4 5 6 7 3 4 5 6 7 1 2 1 2 3 4 5 6 7 3 4 5 6 7 Will post by 4121/06 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Carl Hockett TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Iris Hidalgo TELEPHONE: (707) 588-5061 LICENSING EVALUATOR SIGNATURE:---:~I!;:J.:::L......::!::::::::~---- DATE: 04/21/2006 I acknowledge receipt of this form and unders FACILITY REPRESENTATIVE LIC809 (FASJ • (06104) SIGNATURE:L.;.......;.;..---.,~~;.....:::;___ _ __ DATE: 04/21/2006 Page: 20f2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste A·230 Rohnert Park, CA 94928 FACILITY EVALUATION REPORT FACILITY NAME: DIRECTOR: ADDRESS: CITY: CHILDREN'S COTIATE- PRESCHOOL FACILITY NUMBER: WELCH , MARY 1078 EAST AVENUE NAPA FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA CAPACITY: 45 TYPE OF VISIT: Prelicensing MET WITH: Mary and Ray Welch CENSUS:O UNANNOUNCED DEFICIENCY INFORMATION FOR THIS PAGE: No Deficiency Cited CIVIL PENALTY INFORMATION: 283005477 850 (707) 224-3825 94559 DATE: TIME BEGAN: TIME COMPLETED: 05/21/2004 09:15AM 11 :34 AM COMMENTS/DEFICIENCIES 1 2 3 4 5 Pre-licensing change of location visit conducted this date to inspect this CCC for initial licensing compliance . Today the physical plant and play yards were inspected . Mr. and Mrs Welch currently are licensed to operate the "CHILDREN'S COTIAGE" 2590 First St. in Napa. This facility will be licensed as a combination center with the other licensed component being licensed to care for school-age children. The combined total capacity will not exceed ninety-five children. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Today the preschool classrooms were inspected along with the play yards . The classrooms are all individual rooms but connected together via interior doors. The classrooms are furnished with age and developmentally appropriate furniture , toys and educational materials. The floor surfaces are linoleum and carpet. The center is adequately lit and ventilated. Available on site are cubbies for the storage of children's personal belongings. The children's bathrooms are in operational order, water temperature accessible to children does not exceed 120 F. Napping equipment is available. There are no toxins or cleaning agents accessible to children . The play yards are spacious and fenced with surface areas of bark, grass and asphalt. Shade and drinking water are available outdoors. The interior area/bathrooms/sinks and play yard will allow for the capacity of the forty-five children requested on the application. This facility will be licensed once the fire clearance is verified . Failure t~ ccrrect the cited dgfic!ency{!es), a civil penalty assessment. 0:1 or befcro the Plan cf Ccrract:cn {PCC) dua SUPERVISOR'S NAME: Diane Hoffmann =?ADmJ clat~, may :-asu!t ;., TELEPHONE: 707.588.5026 LICENSING EVALUATOR NAME: Myrtle TELEPHONE: 707.588.5039 LICENSING EVALUATOR DATE : 05/21/2004 SIGNAT~/A.f:--~~ I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. DATE: 05/21/2004 LIC809 (FAS) • (4/96) STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Redwood Empire CC, 101 Golf Course Dr. Ste A-230 Rohnert Park, CA 94928 FACILITY EVALUATION REPORT FACILITY NAME : DIRECTOR: ADDRESS: CITY: CHILDREN'S COTIATE- PRESCHOOL FACILITY NUMBER: WELCH , MARY 1078 EAST AVENUE NAPA FACILITY TYPE: TELEPHONE: ZIP CODE: STATE:CA CAPACITY: 45 TYPE OF VISIT: Prelicensing MET WITH: Mary and Ray Welch DATE: TIME BEGAN: TIME COMPLETED: CENSUS: 0 UNANNOUNCED DEFICIENCY INFORMATION FOR THIS PAGE: No Deficiency Cited 283005477 850 (707) 224-3825 94559 05/21/2004 09:15AM 11:34 AM CIVIL PENALTY INFORMATION: COMMENTS/DEFICIENCIES 1 2 3 4 5 Pre-licensing change of location visit conducted this date to inspect this CCC for initial licensing compliance . Today the physical plant and play yards were inspected . Mr. and Mrs Welch currently are licensed to operate the "CHILDREN'S COTIAGE" 2590 First St. in Napa. This facility will be licensed as a combination center with the other licensed component being licensed to care for school-age children. The combined total capacity will not exceed ninety-five children . 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Today the preschool classrooms were inspected along with the play yards . The classrooms are all individual rooms but connected together via interior doors. The classrooms are furnished with age and developmentally appropriate furniture , toys and educational materials. The floor surfaces are linoleum and carpet. The center is adequately lit and ventilated . Available on site are cubbies for the storage of children's personal belongings. The children's bathrooms are in operational order, water temperature accessible to children does not exceed 120 F. Napping equipment is available. There are no toxins or cleaning agents accessible to children. The play yards are spacious and fenced with surface areas of bark, grass and asphalt. Shade and drinking water are available outdoors. The interior area/bathrooms/sinks and play yard will allow for the capacity of the forty-five children requested on the application. This facility will be licensed once the fire clearance is verified. Failure to correct the cited deficiency(ies}, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Diane Hoffmann LICENSING EVALUATOR NAME: Myrtle LICENSING EVALUATOR TELEPHONE: 707.588.5026 Herin-Wahlstrom .~ _/ - TELEPHONE: 707.588.5039 SIGNATURE: ~~~-DATE: 05/21 /2004 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: _ _ _ _ _ _ _ _ _ __ ~ IC809 (FAS) • (4/96) DATE: 05/21 /2004 Page : 1 of 1 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT Redwood Empire CC, 101 Golf Course Dr. Ste A·230 Rohnert Pari<, CA 94928 FACILITY NAME: CHILDREN'S COTTATE- PRESCHOOL ADMINISTRATOR: WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CA CENSUS: 0 CAPACITY: 45 UNANNOUNCED TYPE OF VISIT: Mary and Ray Welch MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN : TIME COMPLETED: 283005477 850 (707) 224-3825 94559 05/21/2004 09:15AM 11 :34 AM NARRATIVE 1 2 3 4 5 Pre-licensing change of location visit conducted this date to inspect this CCC for initial licensing compliance . Today the physical plant and play yards were inspected. Mr. and Mrs Welch currently are licensed to operate the "CHILDREN'S COTTAGE" 2590 First St. in Napa . This facility will be licensed as a combination center with the other licensed component being licensed to care for school-age children . The combined total capacity will not exceed ninety-five children . 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Today the preschool classrooms were inspected along with the play yards . The classrooms are all individual rooms but connected together via interior doors. The classrooms are furnished with age and developmentally appropriate furn itu re, toys and educational materials . The floor surfaces are linoleum and carpet. The center is adequately lit and ventilated . Available on site are cubbies for the storage of children's personal belong ings . The children's bathrooms are in operational order, water temperature accessible to children does not exceed 120 F. Napping equ ipment is available . There are no toxins or cleaning agents accessible to children. The play yards are spacious and fenced with surface areas of bark, grass and asphalt. Shade and drinking water are available outdoors. The interior area/bathrooms/sinks and play yard will allow for the capacity of the forty-five children requested on the application . This facility will be licensed once the fire clearance is verified. SUPERVISOR'S NAME: Diane Hoffmann TELEPHONE: 707 .588.5026 LICENSING EVALUATOR NAME: Myrtle Herin-Wahlstrom TELEPHONE: 707 .588.5039 LICENSING EVALUATOR SIGNATURE: ••• SIGNED ••• DATE: 05/21/2004 I acknowledge receipt of this form and understand my licensing appeal rights as expla ined and received. FACILITY REPRESENTATIVE SIGNATURE: ••• SIGNED ••• DATE: 05/21/2004 This report must be available at the facility for public review (3 years). LIC809 (FAS) • (06/04) Page : 1 of 1 ---- State of California Department of Social Services Facility Number: 283005477 Effective Date: 05/21 /2004 Total Capacity: 64 In accordance with applicable provisions of the Health and Safety Code of California , and its rules and regulations ; the Department of Social Services hereby issues this License to CHILDREN'S COTTAGE CHILD CARE INC . to operate and maintain a DAY CARE CENTER Name of Facility CHILDREN'S COTTAGE- PRESCHOOL 1078 EAST AVENUE NAPA, CA 94559 This License is not transferable and is granted solely upon the following : PROBATIONAL- EXPIRATION DATE: 06/24/2014 COMBINATION CENTER TO SERVE WELL CHILDREN. AGES 2 YEARS UNTIL ENTRY INTO FIRST GRADE. CAPACITY 64 TOTAL COMBINED CAPACITY FOR BOTH CENTERS SHALL NOT EXCEED 84 CHILDREN . Client Groups Served: CHILDREN Complaints regarding services provided in this facility should be directed t6 : CCLD Regional Office Jeffrey Hiratsuka Deputy Director, Community Care Licensing Division LIC203A (03/07) FAS Pnnt Date 01/05/2012 (707) 588-5026 Authorize'd Represe~tative of { POST IN A PROMINENT PLACE icensing Agency CU-TA018b 6 LEGAL DIVISION Department of Social Services Office of Chief Counsel DARRYL E. EAST Assistant Chief Counsel MARIAM 0 . KAVIANI, State Bar No. 252071 Staff Attorney 744 P Street, MS 8-5-161 Sacramento, CA 95814 Telephone Number: (916) 657-3636 Facsimile Number: (916) 657-2470 7 Attorneys for Complainant 1 2 3 4 5 BEFORE THE DEPARTMENT OF SOCIAL SERVICES STATE OF CALIFORNIA 8 9 10 11 12 13 14 15 16 IN THE MATTER OF: CHILDREN 'S COTTAGE CHILD CARE , INC. dba Children 's Cottage - Preschool 1078 East Avenue Napa , CA 94559 CDSS No. 7210039001z ACCUSATION (Revocation of Probationary License) CHILDREN 'S COTIAGE CHILD CARE, INC. dba Children's Cottage Child Care , Inc.Infant 1078 East Avenue Napa, CA 94559 CDSS No. 7210039001Bz ACCUSATION (Revocation of Probationary License) 17 Respondent. 18 19 JURISDICTION 20 1. This matter arises under the California Child Day Care Facilities Act, 21 Health and Safety Code section 1596.70 et seq ., which governs the licensing and 22 operation of child day care centers. 23 2. The regulations wh ich govern the licensing and operation of child day 24 care centers are contained in California Code of Regu lations, title 22, section 101151 et 25 seq .1 26 Subsequent references to any regulation section(s) are to Title 22 of the California Code of Regulations. 27 CC Accusation_Revoke Probation .doc 1 1 3. The California Department of Social Services ("Department") is the 2 agency of the State of California responsible for the licensing and inspection of child da 3 care centers. 4 4. Administrative proceedings before the Department must be conducted in 5 conformity with the provisions of the California Adm inistrative Procedure Act, Chapter 5, 6 Government Code section 11500 et seq. 7 5. Pursuant to Health and Safety Code section 1596.854, the Department 8 may institute or continue a disciplinary proceeding against a licensee following the 9 suspension, expiration, or forfeiture of a license . 10 6. Pursuant to Health and Safety Code section 1596.887(b) and 1596.889, 11 the standard of proof to be applied in this proceeding is the preponderance of evidence. 12 THE PARTIES 13 7. Complainant DAVID F. DODDS is the Interim Deputy Director of the 14 Community Care Licensing Division of the Department. Pursuant to Government Code 15 section 11503, complainant files this Accusation in his official capacity. 16 8. Respondent CHILDREN'S COTTAGE CHILD CARE, INC. 17 ("Respondent") is licensed by the Department to operate a child day care center at 1078 18 East Avenue, Napa, California ("facility No.1"). Facility No. 1 was initially licensed on 19 May 21,2004. Respondent CHILDREN'S COTTAGE CHILD CARE, INC. 20 ("Respondent") is also licensed by the Department to operate an infant center at 1078 21 East Avenue , Napa, California ("facility No.2"). Facility No.2 was initially licensed on 22 November 2, 2009 . Facility No. 1 and Facility No. 2 are referred to collectively hereafter 23 as "facilities." A copy of Respondent's most recent licenses setting forth the capacity, 24 limitations, and effective dates accompanies this Accusation as ATTACHMENT A and 25 is incorporated by reference. 26 27 9. On or about August 6, 2010 , the Department filed an Accusation to revoke Respondent's licenses to operate Facility No. 1 and Facility No.2. The August 6, CC Accusation_ Revoke Probation .doc 2 1 2010 Accusation was subsequently amended on March 1, 2011 ("2011 Accusation") . 2 The Department and Respondents entered into a Stipulation and Waiver which was 3 adopted by the Department as its Decision and Order on June 24, 2011 ("Stipulation") . 4 Pursuant to the terms of the Stipulation, Respondent's licenses were revoked and it was s granted probationary licenses for a three (3) year period subject to specified limitations 6 and conditions. Among the pertinent terms and conditions of the Stipulation is the 7 requirement that Respondent operate the facilities in strict compliance with the 8 regulations and statutes governing the operation of a child care center. Copies the 9 2011 Accusation and the Stipulation accompany this Accusation as ATTACHMENT B, 10 respectively, and are incorporated by reference. 10. Respondent, by virtue of licensure, must operate in accordance with the 11 12 statutes and regulations governing the licensing and operation of child day care centers. 13 Copies of the applicable statutes and regulations accompany this Accusation as 14 ATTACHMENT C and are incorporated by reference. FACTUAL ALLEGATIONS 15 16 SUBJECT MATTER: CARE AND SUPERVISION/PERSONAL RIGHTS 17 APPLICABLE LAW: Health and Safety Code section 1596.885(a), (b) 18 Regulation sections 101430, 101419.2, 101438.3(b), 19 101223(a)(2), 101229(a)(1 ), 101239(a)(2), and 101229 2o ALLEGATIONS : 11 . Respondent failed to provide proper care and supervision to children in 21 22 care at the facilities, including as follows: 23 A. On or about December 18, 2012, at facility 1, children in care were 24 required to remove their shoes and socks outside, before entering the classroom a 2s the facility, and had to walk barefoot on cold and/or wet pavement to get to the 26 classroom. 27 II CC Accusation_Revoke Probation .doc 3 1 B. On or about December 18, 2012, at facility 2, infants were left in 2 high chairs for an appreciable period of time wherein the infants were neither being 3 fed nor eating. 4 C. On or about December 18, 2012, at facility 2, Respondent failed to 5 have the needs and services plans completed for each infant, thereby failing to 6 gather information regarding whether or not infants in care were able to eat solid 7 foods and/or foods that require chewing. 8 0. On or about October 10, 2012 and on other occasions currently 9 unknown to complainant, at facility 1, children engaged in inappropriate behavior, 10 including but not limited to: pulling their pants down, touching each other's genital 11 areas and/or other inappropriate activity, while on the playground at the facility. 12 E. On or about September 28, 2012, at facility 2, infants in care and 13 preschool age children in care were comingled in the same activity area, in 14 violation of Department Regulations that require indoor infant activity space to be 15 physically separate from indoor play areas for children in care. 16 F. On or about May 21, 2012, at facility 1, children in care were left in 17 the classroom without a teacher while the supervising teacher went to the store 18 room to collect equipment, in violation of Department regulations which require 19 children to be under visual supervision of staff at all times. 20 G. 21 On or about April 6, 2012, at facility 2, an infant in care was left to cry in a high chair for an appreciable period of time until s/he fell asleep. 22 H. On or about August 29, 2011, at facility 2, a teacher placed an 23 infant in care on a changing table and then walked across the room leaving the 24 infant on the changing table unattended, creating a risk of harm to the infant. 25 II 26 II 27 II CC Accusation_Revoke Probation.doc 4 l SUBJECT MATIER: PHYSICAL PLANT 2 APPLICABLE LAW: Health and Safety Code section 1596.885(a), (b) Regulation section 101238 3 4 5 6 7 8 9 10 11 ALLEGATIONS: 12. Respondent failed to maintain the physical premises of the facilities, including as follows: A. On or about May 29, 2013 , at facility 2, Respondent left partially open cans of paint on a pathway used by infants in care. B. On or about May 29, 2013, at facility 2, Respondent allowed leaves and debris to clutter the sand box and play yard where infants in care play. C. On or about December 18, 2012, at facility 1, a multi-tiered metal 12 shelf was hanging precariously in an area accessible to children in care, creating a 13 risk of harm to children in care. 14 D. On or about May 18,2012, at facility 1, the drinking water fountain 15 intended for use by children in care, was not properly maintained and did not 16 deliver adequate water for children to drink. 17 18 E. On or about May 18, 2012, at facility 1, a large bookcase was not secured and/or anchored to the wall, creating a risk of harm to children in care . 19 SUBJECT MATTER: Health-Related Services 2o APPLICABLE LAW: Health and Safety Code section 1596.885(a), (b) Regulation section 101226 21 22 23 24 2s ALLEGATIONS: 13. Respondent failed to abide by the ratio and/or capacity limits of its probationary licenses to operate the facilities, including as follows: A. On or about May 29, 2013, at facility 2, Respondent allowed staff to 26 apply sunscreen to infants in care without first receiving written permission from 27 each infant's parents/guardians. CC Accusation_Revoke Probation .doc 5 1 SUBJECT MATTER: RATIO/CAPACITY 2 APPLICABLE LAW : Health and Safety Code section 1596.885(a), (b) Regulation section 101416.5 3 4 5 6 7 8 9 ALLEGATIONS: 14. Respondent failed to abide by the ratio and/or capacity limits of its probationary licenses to operate the facilities, including as follows: A. On or about December 18, 2012, at facility 2, one teacher was supervising eight infants, in violation of Department regulations. B. On or about September 28, 2012 , and on other occasions currently 1o unknown to complainant, at facility 2, one teacher was providing care for eleven 11 children , including three infants, in violation of Department regulations. 12 SUBJECT MATTER: CONDUCT INIMICAL 13 APPLICABLE LAW: Health and Safety Code section 1596.885(c) 14 ALLEGATIONS: 15 15. Respondent engaged in conduct that is inimical to the health, morals, 16 welfare, or safety of either an individual in or receiving services from the facility, or the 17 people of the State of California as alleged in paragraphs 11 through 14, above, and 18 incorporated here by reference. 19 2o CAUSE FOR DISCIPLINE 16. The facts alleged in paragraphs 11 through 14, individually and/or jointly, 21 constitute violations of licensing laws. These facts provide cause, pursuant to Health 22 and Safety Code section 1596.885( a )-(b) and/or the Stipulation to revoke Respondent's 23 probationary license to operate the facilities. 24 17. The facts alleged in paragraphs 11 through 15, individually and/or jointly, 25 constitute conduct by Respondent wh ich is inimical to the health , morals, welfare, or 26 safety of either an individual in or receiving services from the facility or the people of this 27 state. These facts provide cause, pursuant to Health and Safety Code section CC Accusation_Revoke Probation .doc 6 1 1596.885(c), to revoke Respondent's probationary license to operate the facility. 2 3 PETITION FOR RELIEF 18. WHEREFORE, complainant requests that Respondent CHILDREN'S 4 COTTAGE CHILD CARE, INC.'s probationary license to operate a child care center at 5 1078 Napa Avenue, Napa, California be revoked . 6 19. WHEREFORE, complainant requests that Respondent CHILDREN'S 7 COTTAGE CHILD CARE, INC.'s probationary license to operate an infant center at 8 1078 Napa Avenue, Napa, California be revoked. 9 DATED: DEC 2 4 2013 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 CC Accusation_ Revoke Probation.doc 7 DELEGATION 1. 2. DATE: _ I hereby delegate to JoAnn Hirai, as Chief of Investigations Branch, Mary Jolls as Program Administrator of Adult and Senior Care Program, . Kathi Mowers-Moore, as Chief of the Central Operations Branch, Lori Starnes, Chief of the Technical Assistance and Policy Branch, Angela Valdez, Program Administrator for Children's Residential Program, Paula d'Afbenas, Program Administrator for the Child Care Program; my power to issue the following administrative pleadings under the Administrative Procedure Act, Government Code Section 11500 et seq.: (a) Accusations and orders for temporary license suspension prior to hearing, pursuant to Health and Safety Code Sections 1550, 1550.5, 1568.082, 1569.50, 1569.51, 1569.885, or 1596.886. (b) Statements of Issues pursuant to Health and Safety Code Sections 1526, 1568.063, 1569.22, or 1596.879. (c) Orders to require that an employee or prospective employee of a facility not work or be present in a facility pending a final decision of the m.atter, pursuant to Health and Safety Code Sections 1558, 1568.066, 1569.58, or 1596.8897. They may exercise this power when, in their opinion, the action is necessary to protect the residents or clients from physical or mental abuse, abandonment, or any other substantial threat to the health and safety of the residents or clients. (d) Settlement agreements regarding any of the preceding administrative pleadings pursuant to Government Code section 11415.60. These delegations are made pursuant to Government Code Section 7. They shall remain in effect until explicitly revoked. _;;~~k.t..:::I.:!J::.....___ Qta~ Director California Department of Social Services 1 6 LEGAL DIVISION Department of Social Services Office of Chief Counsel DARRYL E. EAST Assistant Chief Counsel MARIAM 0. KAVIANI , State Bar No . 252071 Staff Counsel 7 44 P Street, MS 8-5-161 Sacramento, CA 95814 Telephone Number: (916) 657-3636 Facsimile Number: (916) 657-24 70 7 Attorneys for Complainant 2 3 4 5 8 BEFORE THE DEPARTMENT OF SOCIAL SERVICES STATE OF CALIFORNIA 9 10 11 12 13 14 15 16 IN THE MATTER OF : CHILDREN'S COTTAGE CHILD CARE , INC . dba Children's Cottage Preschool 1078 East Avenue Napa, CA 94559 CHILDREN 'S COTTAGE CHILD CARE, INC . dba Children's Cottage Child Care - Infant 1078 East Avenue Napa, CA 94559 17 CDSS No. 7210039001 OAH No. 2010090381 CDSS No . 7210039001B OAH No. 2010090381 STIPULATION , WAIVER AND ORDER . Res ondent. 18 19 RESPONDENT Children 's Cottage Ch ild Care, Inc., dba Children's Cottage 20 Preschool and dba Children's Cottage Child Care- Infant (hereafter collectively 21 "Respondent"), having obtained the counsel of Phillip M. Cunningham, has been fully 22 advised of the charges of the Accusation in this matter (a copy of which is attached 23 hereto as Exh ibit 1 and incorporated herein by reference), and hereby enters into the 24 following Stipulation with the COMPLAINANT, Jeffrey Hiratsuka, as a means of 25 achieving a full and final resolution of the Accusation in lieu of an evidentiary hearing 26 and decision . 27 CCC revocation stayed with probation .docx 1 Respondent and compla inant hereby stipulate and agree as follows: 2 1. FINDINGS: Respondent admits the allegations in the Accusation and 3 agrees that for purposes of this matter and all other matters between the Department 4 and the Respondent, the allegations of the Accusation are found to be true and to 5 constitute a legally sufficient basis to revoke Respondent's license . 2. 6 REVOCAT ION : STAYED WITH PROBATION: Respondent's license to 7 operate a child day care center at 1078 East Avenue, Napa , California and 8 Respondent's license to operate an infant center at 1078 East Avenue, Napa , California 9 are revoked upon the Department's adoption of this Stipulation and Waiver as its Order. 10 The revocation of the licenses shall be STAYED, for three years during which time the 11 Respondent shall be granted a probationary license for each facility, subject to the 12 following limitations and conditions: A. 13 14 Respondent agrees to operate the facility in substantial compliance with the regulations and statutes governing the operation of a child care center; B. 15 During ·the period of probation, the Department in its sole discretion 16 may conduct unannounced site visits for the purpose of determining whether there 17 is full compliance with the regulations and statutes governing the operation of a 18 child care center; C. 19 During the period of probation, Children 's Cottage Child Care, Inc. 2o shall be operated by a Board of Directors that shall have no fewer than three (3) 21 board members. 22 i. During the period of probation, Ray Welch and Mary Welch shall not serve on the board or directors concurrently. 23 ii. 24 During the period of probation, all board members shall. 25 within one hundred and twenty (120) days of appointment to the Board , attend a 26 Child Care Operations and Record Keeping Orientation. 27 // CCC revocation stayed with probation .docx 2 1 D. Within thirty (30) days of the effective date of this Stipulation, 2 Respondent shall submit to the Chico Regional Office- Rohnert Park Local Un it of 3 the Community Care Licensing Division (hereafter "Licens ing") a written roster of 4 the current board members, the ir titles and their duties ; E. 5 Within thirty (30 ) days of the effective date of this Stipulation , 6 Respondent shall meet with the regional manager and local un it manager at the 7 local licensing office. Within fifteen (15) days of that meeting , Respondent shall 8 submit to the licensing office a written summary of its hiring and training practices , 9 including job descriptions for each position at the facility; F. 10 Within thirty (30) days of the effective date of this Stipulation, Respondent shall submit to Licensing an organization chart for each facility; 11 G. 12 Within thirty (30) days of the effective date of this Stipu lation, 13 Respondent shall submit to Licensing a new parent handbook and admission 14 agreement fo r review and approval ; H. 15 Respondent shall require the director of each facility to attend a · Child Care Operations and Record Keeping Orientation with in one hundred and 16 twenty days (120) of the effective date of this Stipulation ; 17 I. 18 Respondent shall provide quarterly training to facility staff on 19 applicable Title 22 regulations . Respondent agrees to keep a record of staff who 20 attends such trainings and to submit such records to Licensing on a quarterly 21 basis. Licensing staff shall participate in at least one (1) tra ining session per year, 22 in an effort to facilitate communication between facility staff and licensing staff; J. 23 During the period of probation, the Board of Directors shall have 24 quarterly meetings . The minutes of each meeting shall be subm itted to Licensing 25 within seven (7) days of the meeting date; 26 II 27 II CCC revocation stayed with probation .docx 3 K. 1 Respondent shall ensure that all individuals working, residing or 2 volunteering in the facility, including any in dividual named or acting as the Chief 3 Operating Officer, shall obtain criminal record clearances or exemptions and shall 4 maintain proof of such criminal record clearances or exemptions at the facility; 5 L. Respondent shall maintain current personnel records of each 6 employee at the facility and ensure that all employees have a current certificate of 7 CPR and first aid training on file; 8 9 M. roster, which must be made available to the Department upon request; 1o 11 Respondent is required to maintain an accurate and current client N. This Stipulation shall be posted in a conspicuous place at the facility for thirty (30) days, beginning on the effective date of this Stipulation; 0. 12 A copy of this Stipulation shall be provided to the parent/guardians 13 of all children currently enrolled at Respondent's facility, as well as any and all 14 children enrolled at the facility during the probationary period . Respondent shall 15 keep verification of receipt in each child's file at the facility which must be made 16 available to the Department upon request; P. 17 Respondent shall ensure that the proper ratios are maintained at all 18 times in accordance with the provisions of California Title 22 , Regulation section 19 101216.3; 2o Q. Respondent shall develop and implement a plan of supervision for 21 children in care, both inside the facility and outdoors in the play area . The plan 22 must include specific information on how supervision will be carried out based on 23 the floor plan of the facility and the configuration of the outdoor play areas . The 24 plan must include a provision detailing how Respondent will assess the daily need 25 for staffing to ensure supervision is met at all times . This plan shall be subm itted to 26 Licensing for approval within 30 days of the effective date of this Stipulation and 27 Order. CCC revocation stayed with probation .docx 4 ·. R. 1 Respondent shall implement and continue to maintain procedures 2 to ensure the proper care and supervision of children in its care in compliance with 3 the provisions of California Title 22 Regulation section 101229; S. 4 5 Title 22, Regulation section 101212; T. 6 During the period of probation, Respondent shall not: (i) 7 8 Respondent shall abide by the reporting requirements of California allow Ray Welch to work, volunteer or be regularly present a any of the licensed facilities during the hours of operation; (ii) 9 allow Ray Welch to hold any position wherein he would be 10 responsible for personnel matters such as hiring, termination, discipline or 11 promotion of employees . U. 12 13 14 Respondent shall ensure that the facility is clean , safe , sanitary and in good repair at all times for the safety and well-being of clients, employees and ·visitors; V. 15 Respondent shall develop and implement a detailed cleaning plan 16 for the facilities. This plan shall be submitted to Licensing within 30 days of the 17 effective date of this Stipulation and Order. Respondent shall not assign cleaning 18 tasks to child care staff while they are providing care and supervision to children. W. 19 Respondent may request in writing an additional thirty (30) day 2o extension of any of the abovementioned terms. The Department will grant or deny 21 any request for a thirty (30) day extension in its sole and absolute discretion . 22 23 24 3. FUTURE APPLICATION FOR A LICENSE. CERTIFICATION AND TRUSTLINE REGISTRY: A. Licensure and Certification: Respondent shall not apply for, rece ive 25 or hold any license or certification to operate any care facility licensed by the 26 Department of Social Services includ ing but not limited to any community care 27 facility (CCF), certified family home (CFH), residential care facility for the elderly CCC revocation stayed with probation.docx 5 1 . (RCFE), residential care facilities for persons with chronic, life-threatening illnesses 2 (RCFCI) or child day care facility (CDCF) (as CCF, CFH, RCFCI, RCFE, and 3 CDCF are defined in sections 1502(a), 1506(d). 1568, 1568.01, 1569.2, and 4 1596.750 of the Health and Safety Code) other than the probationary license 5 issued herein, for a period of three (3) years from the effective date of the Order 6 adopting this Stipulation . A new probationary license issued solely upon a change 7 of location is not prohibited by this paragraph . B. 8 Respondent understands and agrees that the Department may 9 . 'deny any application submitted after three (3) years from the effective date of the 1o Order adopting this Stipulation, in whole or in part based upon the findings in this 11 Stipulation. However, Respondent shall be entitled to a hearing subject to the 12 appeal on the denial of the license and the timely filing of a Notice of Defense after 13 14 ·the Department has served Respondent with a Statement of Issues. 4. TOLLING OF PROBATIONARY PERIOD: The probationary period is 15 tolled during any period when the facility is not operating. The probationary period shall 16 be extended by the total time during which the facility is not operating . 17 5. COMPLETION OF PROBATION : If Respondent has successfully 18 complied with the terms of this Stipulation , at the end of three (3) years from the 19 ·effective date, the conditions imposed upon Respondent's license will expire and 2o Respondent's license shall be granted or restored in full. 21 6. VIOLATION OF STIPULATION TERM: Respondent agrees that 22 violation of any of the terms of probation or any of the other terms of this Stipulation 23 shall constitute sufficient grounds for the revocation of the probationary license granted 24 herein. the exclus ion of Respondent from employment, residence or presence in a 25 licensed facility, and from having contact with clients of a licensed facility. In such an 26 event, Respondent shall be entitled to an administrative hearing before the Office of 27 Administrative Hearings on the sole issues of whether there was a serious or substantial CCC revocation stayed with probation .docx 6 1 violation of a material term and/or condition herein, and whether Respondent has 2 caused and/or permitted such a violation . Upon a finding that a condition or term of 3 probation or any of the other terms of this Stipulation was violated , the probationary 4 license shall be revoked and Respondent shall be excluded from facilities licensed by 5 the Department. Respondent agrees that valid service of an accusation to revoke the 6 probationary license provided herein may be effectuated by certified mail at the addre ss 7 designated for servi ce with the California Secretary of State or at an address listed in a 8 subsequently issued probationary license . 9 1 o 7. DEPARTMENT' S AUTHORITY: The fact that the Department may decline or omit to take immediate disciplinary action for a violation of a condition of 11 probation or any of the other terms of this Stipulation does not constitute a waiver by th e 12 Department of the right to raise that violation at a later date in a disciplinary proceeding 13 or in any other context. Respondent understands that nothing in this Stipulation is to be 14 construed to limit the authority of the Department to impose discipline for violations of 15 statutes and regulations applicable to Respondent. If any accusation seeking to revoke 16 probation is filed by the Department during the period of probation , then the period of 17 probation and the probationary terms shall be extended, if necessary, beyond three (3) 18 years and shall rema in in force and effect until such time as the Department issues a 19 final Decision and Order on the accusation . 2o 8. MONITORING FEE: Respondent understand that it must pay a 21 probation monitoring fee equal to the annua l fee for the license du ring the period of 22 probation as required by Health and Safety Code Section 1596.803. 23 9. WAIVER OF HEARING RIGHTS: The parties wa ive their rights to a 24 hearing in this matter, to present any evidence on their behalf and to cross-examine 25 witnesses testifying on the other party's behalf. The parties further waive thei r rights to 26 fu.rther discovery in this matter. 27 // CCC revocation stayed with probation .docx 7 10. 1 WAIVER OF APPEAL/MODIFICATION RIGHTS: Respondent waives 2 all rights of review arising out of this action or this Stipulation or the Order implementing 3 it, including but not limited to a petition for reinstatement, reduction of penalty, or 4 rehearing, writ of administrative mandamus , any other judicial or administrative review 5 or any other right or ability he/she may have to seek to have this agreement modified or 6 set aside on any grounds whatsoever. 11 . WAIVER OF CLAIMS: The parties waive all known or unknown legal 7 8 actions or claims against each other, or their employees or agents, which they may 9 have acquired or come to acquire arising out of this matter, with the following 1o exceptions: 11 A. Civil penalties ; 12 B. Monitoring fees; and 13 C. Any action arising out of an audit or other review to establish , 14 modify, preserve, enforce, or to recover an overpayment or to reimburse an 15 underpayment of public or private funds. 12 . SEVERABLE TERMS : If any provision of this Stipulation is held to be 16 17 invalid, the invalidity will not affect other provisions or applications of the Stipulation, 18 which can be given effect without the invalid provisions, and to this end, the provisions 19 of th(s Stipulation are severable . 2o 13. PUBLIC RECORD: This Stipulation is a public record as required by 21 section 11517(d) of the Government Code. It is accessible to the public pursuant to the 22 Public Records Act, section 6250 et seq . of the Government Code. 23 14. SIGNATURES: A facsimile ofthe signature page of this Stipulation will 24 bind the signing party or parties to the terms and conditions herein once any rema ining 25 party or parties execute the document and once the Order is executed. 26 II 27 // CCC revocation stayed with probation .docx 8 05/27/2011 63:26 7072268118 CHILDRENS COTT PAGE 1 15. COUNTERPARTS; This Stipulation may be executed in counterparts . 2 16. EFFECTIVE DATE: Th is Stipulation is effective on the date on wh ich 3 02 the Department's Order adopting it is executed . · 17. NO ORAL MODIFICATION: This Stipulation constitutes the entire ..; c agreement between the parties w ith respect to the Accusation in th is case. Moreover, 6 the terms of this Stipulation cannot be amended except in writing , signed by all the 7 parties thereto . IT IS SO STIPULATED : 8 9 10 DATE~ 7 11 12 13 Mariam 0 . Kavian i Staff Coun sel Attorney for Complaina 14 16 17 JUN 2; 4 2011 JEF Y HI A SU Deputy Director Community Care Licensin~ Division Department of Social Serv1ces State of California DATED 18 19 20 DECISION AND ORDER 21 The preceding Stipulation hereby is adopted by the Department as its 22 Decision in this matter. 23 IT IS SO ORDERED THIS J. L{ ~ DAY OF J u.. V'l e.__ 1 24 25 26 DA 27 Assistant Ch ief Counsel Legal Division revocation stayed with probation.docx YL E. EAST 9 201 1, DELEGATIOt\J 1. 2. I hereby delegate to JoAnn Hirai. as Chief of Investigations Branch, John Rodriquez, as Chief of Continuing Care Contracts Branch, Gloria Merk, as Program Administratm of Child Care Program, Sergiu Ramirez, as Program Adminisirator of Children 's l~esJdeni1al Program, lvlary Jails as Pro91<1111 Administrator of .A.dult and Ssnior Care Program; my power to issue the following admmistralive pleadings under ltle Administrative Procedure Act, Government Code Section 11500 et seq .: (C~) Accusations and orders for temporary license suspens ion prior to hearing, pursuant to Health and Safety Code Sect ions 1550, 1550.5. 1568.082,1559.50,1569.51. 1569.f..e5, or 1596 .886. (b) Statements of Issues pursuant to Health and Safety Code Sections 1526, 1568.063, 1569.22, or ·1596.379. (c) Orders lo require that an employee or prospective employee of e facility not .vork or be present in a facility pending a final decision of the matter, pursuant to Health and Safety Code Sections 1558, 1568.066, 1569.58, or 1596.8897. They may exercise this power wl1en. in tileir opinion . t11e action is necessary to protect the residents or clients from physical or rnental abuse, abandonment, or any other substantial threat to the~ heallh and safety of the residents or clients . These delegations are made pursuant to Government Code Section 7. They shall remain in effect until explicitly revoked. DATE: ------------------------WILL LIGHTBOURI\JE Director California Department of Social Serv1ces STATE OF CALIFORNIA-HEALTH At~D HUMAN SERVICES AGENCY DEPARTME·N T OF SOCIAL SERVICES CDSS 744 P Street • Sacramento, CA 95814 • wvvw.cdss.ca.gov ,- ARNOLDSCHWARZENEGGER GOVERNOR JOHN A. WAGNER DIRECTOR Licensee must provide a copy of this Summary of Charges to each parent of a child in · care and each parent who applies to have a child in care. Health & Safety Code section 1596.8895(c) SUMMARY OF CHARGES FOR PARENTS OF CHILDREN IN CAR Facility Name: Children's Cottage Child CDSS Case No 721 003900-B The California Department of Social Servicef. has filed an action to take away the license of this child day care business. The iaw requires that the department prepare and the licensee give you a summary of the reasons the department is taking this action . This licensee and the local licensing office have copies of the formal papers we fi led and gave to the licensee. You can get the formal papers at either place by just asking . The department is taking this action , because it believes that the following reasons are true . The licensee -.viii get 2 chance to shov, a judge that they are not true or that even if true are not enough reason to revoke the l;cense . Reasons: • • • • • • • • • • • • A 22-month-old child was left alone and unsupervised. Children's Cottage staff are required to clean the facility when they should be providing care and supervision to children . An infant has been restrained in a hinh chair while staff clean the facility. Children's Cottage has failed to maintain required teacher-child ratios and required teacher-aide ratios. Children's Cottage has provided carE for children in excess of its licensed capacity. The playground has not been kept in a safe condition. Cleaning solutions and other toxins i ,ave not been kept inaccessible to children. Food service and preparation areas have not been kept in a clean condition . Child ren 's Cottage has interfered wilil the Department's inspection authority including the Department's right to interview staff in response to compla ints. Children's Cottage has failed to obtain and/or ma intain proof of required TB testing of staff Children 's Cottage staff forced a ch i! d to remain on a potty chair for 30 minutes. Children's Cottage has fa iled to em ~·ty and clean potty chairs as required. ORIGINAL SIGNED BY SIGNATORY [ill CDSS ,----- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 Will UGHT80URNE DIRECT~ EOMUNO G. BROWN JR. GOVERNOR July 17, 2013 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 1078 EAST AVE NAP A, CA 94559 Dear Yasmin: This letter is in reply to your appeal letter where you discussed your reasons for a citation that was issued by LPA Barbara Lawler at her last visit. After a review of the letter it is unclear as to what you are requesting. I will assume that you are requesting to have this citation dismissed. Section 101238(a) Buildings and Grounds states that child care centers shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well being of children, employees and visitors. You were cited for the laundry room being accessible to children due to the lock that leads from the mat room into the laundry room was broken and laundry detergent visible. In your letter, you state that the laundry room is not used by children at any time, and that they are supervised at all times. Your letter doesn't speak to the lock being broken, but that your children no not to enter into this room. With the lock broken , there is the potential for a child to enter into that room . The scenario in your letter is eloquent in that it describes a good reason to maintain equipment is in good repair at all times to prevent accessibility. I find insufficient evidence to support dismissing this citation, therefore, this citation will be upheld. If you have any questions concerning this appeal , please contact me at (707) 588-5026. Sincerely, Linda Walker Licensing Program Manager chron/facility file ORIGINAL SIGNED BY SIGNATORY STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY-...._./ CALIFORNIA DEPARTMENT OF SOCIAL SERVICES NOTICE OF CIVIL PENALTIES DUE D INVOICE NO. _01_0_15_14 _ __ ~ fZ1 Initial Invoice Final Notice Date Sent 04/10/201 3 REGIONAL OR COUNTY OFFICE NUMBER _0_ 1 _ _ __ FACILITY NAME FISCAL YEAR CHILDREN'S COTTAGE-PRESCHOOL I PHYSICAL ADDRESS FACILITY TYPE 1078 EAST AVENUE I I CITY FCCH ZIP CODE STATE NAPA I DATE LIC 422 SENT 12/13 CA 01 /11 /201 1 PENALTY PCA CODE 84035 94559 MAILING ADDRESS 1078 EAST AVENUE FACILITY NUMBER I CITY I I ZIP CODE STATE I NAPA CA 94558 283005477 ' - - - - - - - - - - - - - - - - - __j LICENSEE(S) OR UNLICENSED FACILITY OPERATOR I CHILDREN'S COTTAGE CHILD CARE INC . SUPERVISOR APPROVAL ADDRESS LINDA WALKER 1078 EAST AVENUE CITY STATE I CA NAPA On 01 /03/2011 TITLE ZIP CODE LPM I 94559 DATE 01 /05/20 11 your facility was found to be in violation of one or more sections of the California Health and Safety Code. DATE See attached LIC 421 se ries form . As a result, you were assessed the following amount: (DATE) Penalty Amount Originally Assessed : 01 /03/20 11 $ 150.00 (DATE) $ Penaltv Amount Amended: (DATE) Payment Received: $ Balance Due : $ 150.00 Send a copy of this notice and your payment to the address shown below within 10 days. MAKE CHECKS PAYABLE TO THE CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. Please write your invoice and facility number(s) on your check. To : CIVIL PENALTY COORDINATOR COMMUNITY CARE LICENSING 101 GOLF COURSE DRIVE , STE . A-230 ROHNERT PARK, CA 94928 FAILURE TO PAY CIVIL PENALTY MAY RESULT IN ANY OR ALL OF THE FOLLOWING: • SEIZURE OF PERSONAL INCOME TAX REFUNDS • LICENSE DENIAL, SUSPENSION, OR REVOCATION • COURT ACTION LIC 422 (9/11) (PUBLIC) ' - >( ..-"" ;! 6 _,, ......... 4 __ I '· \"'""\r\. ' r-,.....J - CDSS Wl ~ l LIGHTB OU RN£ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 101 GOLF CO URSE DR. STE . A-2 30 ROHN ER T PAR K, CA 94928 :.Ji i~ E. ~~ "' :: ~ ED MU ND G BR OW!'< JR ·=•:J·..:::r~N · :: ;:: July 19, 2012 CHILDRE N'S COTTAG E - PRESCHOOL- 283005477 1078 EAST AV E NAPA CA 945 59 Dear Ya sm in: This letter is in reply to your appeal letters received in both April and May 2012. In your letters yo u have requested that the following citations of criminal record clearances; build ing and grounds; outdoor activity spaces and care and supervision be dismissed tha t were issued. In this letter I will address these citations individually. Regarding the citation Section 101238, Outdoo r Activity Space issued on May 21, 2012 , you state in you r letter that on May 18, 2012, Licensing Program Analyst, Barbara Lawler stated on the report that the climbing structu res are cushioned by chipped bark with adequate depth and on May 21 , 2012 issued a citation for the yard not having sufficient cush ioning material under climbing structures . This citation wi ll be dismissed based on citation issued May 21 , 20 12 contradicts previous report of May 18, 2012. You are also requesting that the citation Section 101229, Responsibility for Providing Care and Supervision be dismissed, that yo u determined that there wasn't any immediate risk to children ; and that they were not in an environment that they could of been hurt. You also state they were being visually supervised while the teacher was setting out the mats in the same room. I spoke with Ms. Lawler as well as reviewed the report. The licensing report reflects that the teacher was in a storage room gathering mats for nap time. I have spoken with Barbara who stated where the storage room is located prevents visual supervision. She also stated that she also observed the teacher to remain in the storage room without checking on the children. This citation will remain as part of your record due to insuffici ent evidence was presented to support the findings and the observations of the LPA. Section 101238(a) Bu ildings and Grounds was cited due to a bookcase was not secured during the visit. You state that this bookcase has never been an issue before. Although this may of been the case on previous visits , it is my understanding that this bookcase was relocated to an area next to the cubbies and gets a lot of traffic and activity. Due to where it is located it does need to be made safe and secure . The citation was appropriately cited and will remain a part of your record. FILE COPY Children's Cottage Infant Center & Preschool 1078 East Ave, Napa CA 94559 (707) 224-3825 ChildrensCottage.com Lie 283007874 & 283005477 Early Care & Education f rom 6 months to 6 years in Napa since 1993 Minutes of Quarterly Board of Directors Meeting Date of Meeting: September 30, 2011 at I 1:30am Place of Meeting: 999 Trancas Street, Napa CA Present at Meeting: Yasmin Solorio-Vallejo, Lisa Crane, Ray Welch Yasmin reported that Barbara Lawler, the new LP A from CCL was scheduled to come to the staff meeting to be held at Children's Cottage on October 4 from 6:15pm to 7:00pm. Yasmin sent an email as requested by CCL supervisor Linda Walker with a list of questions from staff for Barbara. The goal of the meeting is to faci litate communication between faci lity and Licensing staff. Ray reported that 8 people attended the annual ECE conference at Solano Community College on September 17 which was similarly attended in September 20 10. The Board voted unanimously to continue attending this educational Early Childhood & Education conference again in 2012. Yasmin brought up the annual Professional Association/or Childhood Education (PACE) and the Board unanimously approved sending Yasmin, Susie, Reyna, Jessica, and Daisy to the conference to be held next month in southern California. Lisa brought up the idea of a Christmas party for parents and children. After discussion, there was a tentative date set for Saturday December I 0 from I 2:00pm to 3:OOpm. Pot luck, songs by the kids, and a silent auction were discussed. Yasmin will speak to staff individually and see if the date and events will work with everyone' s holiday schedule. Ray reported that he was working on the new brochure for 2012. After discussion, it was agreed by all Board members that tuition rates would remain the same again this year since we were still in the middle of tough economic times and raising tuition could hurt enrollment of a center which is not full . With no further business to discuss, the meeting was adjourned at I 2:50pm DSS ROHNERT PAR K OCT 0 4 201 1 COMMUNITY CARE LICENSING Children's Cottage Infant & Preschool Center 1078 East Ave, Napa Ca 94559 (707) 224-3825 www.ChildrensCottage.com July 19, 2011 Supervisor Linda Walker Community Care Licensing 101GolfCourse Dr #A-230 Rohnert Park, CA Hi Linda, I heard from my lawyer about corporate organization and he said I got my corporation organization backwards. The Board of Directors is senior to the Corporate Officers. So the President, Secretary, & Treasurer all report to the Board of Directors instead of the Board reporting to the Corporate officers like I incorrectly thought. So some ofthe documents you said you were in receipt of in your July 15 email are incorrect. Specifically, I am sending with this letter a revised Roster of Board Members, Titles & Duties and a revised LIC 309 Administrative Organization with new dates of July 19, 2011 on them. Please disregard the earlier ones as they have the organization backwards and incorrect. I am also sending you something I promised I would send you along with this letter. It is the "Summary of Hiring & Training Practices with Job Descriptions." I sent the Secretary of State a new "Statement of Information" SI-200 C form and asked them to send me a certified copy which I will forward to you as soon as I receive it from them. I am enclosing a copy of that form for you which is not certified. Sincerely, 6€cr~ Ray Welch DEPT. OFIOCIALSERVlCES ROHNfP'rOAOltQJ:~IONA( OFFICE JUL 2 o 20i1 CO MYNITY CAR IC!NSJH Revised July 19, 2011 Children's Cottage Infant & Preschool Center 1078 East Ave, Napa Ca 94559 (707) 224-3825 www.ChildrensCottage.com Roster of Board Members, Their Titles & Duties 1. Yasmin Solaria-Vallejo is one of3 Board members and also serves as a corporate officer in the role of Secretary. As Secretary she has full authority for all personnel matters, including interviewing, hiring, promotion, discipline, and termination of employees, CPR, First Aid, and training in the state child care regulations. She is the facility director for both the infant & preschool component and oversees day to day child care operations. She has the authority to meet with licensing and insure compliance with state regulations. In her role as Secretary, she reports to the Board of Directors. 2. Lisa Crane is one of 3 Board members. The President, Secretary, and Treasurer all report to the Board of Directors. 3. Ray Welch is one of 3 Board members and also serves as President & Treasurer. He is responsible for all banking, payroll, bill paying, bill collecting, advertising, website development & maintenance, and getting bids for repair & maintenance at the facility. In his corporate officer roles (Pres & Treasurer) he reports to the Board of Directors. BOARD OF DIRECTORS President Secretary Treasurer The 3 corporate officers (Pres, Sec, Treasurer) report to the Board of Directors DEPT. OF$0CIALSERVICES ROHNERTOA~XQF.r,IONAL OFFICE JUL 2 0 2011 Children's Cottage Infant & Preschool Center 1078 East Ave, Napa Ca 94559 (707) 224-3825 www.ChildrensCottage.com Quarterly Training to Facility Staff on Applicable Title 22 Regulations On July 6, 2011 the following staff were in attendance: Lisa Crane, Angelica Covarrubias, Yasmin Solorio-Vallejo, Susana Reyes, Kendall Crane, Susie Solorio, Jessica Eusebio, Reyna Vallejo, Daisy Domian, Yenny Gonzalez, Ray Welch Training included discussion on teacher to child ratios with the distinction made between the infant center and the preschool. Infants have a 1-to-4 ratio while the preschool has a 1-to-12 ratio. An infant teacher must have 12 ECE units and 3 of these units have to be a completed infant class. A preschool teacher could have 9 ECE units and be enrolled in 3 more ECE units and be teaching before the last 3 units are completed. Breaks must be given so that ratios and supervision are following the regulations. For example, let's say that there are 8 infants in the baby room with 1 teacher and 1 aide. When the aide takes a break, the person breaking her can be another aide. When the teacher goes for a break, the person breaking her must be a qualified infant teacher. After several questions and answers regarding supervision and breaks, it seemed that all staff were aware of the regulations and knew how they would always be able to stay in compliance with them to ensure the safety and supervision of all children in care at the infant and preschool center. Licensing is invited to attend the next quarterly training in an effort to facilitate communication between facility staff and licensing staff. This is tentatively scheduled for Tuesday October 4 at 6:00pm at 1078 East Avenue in Napa. /'""'- /""""' Children's Cottage Preschool 1078 East Ave, Napa Lie 283005477 ., May 24,2011 Dear Parents, We had a visit from State Licensing and they found that we had enough qualified teachers for the number of children in the preschool but they did not like the fact that one teacher had more than another teacher in their groups so they gave us a violation which is on the other side of this page. We reviewed the regulatio~s and have a plan where a teacher will·come in even earlier in the morning so our staff is better utilized. We are always trying to improve our quality. If you ever have any questions, concerns, or compliments you can ·always call me on my personal cell phone number (707) 287-4297 or email me at info@childrenscottage.com Sincerely, ~~~~~ Yasmin, Director DEPT. OF SOCIAL SERVICES . RDfiNERT PARK REGIONAL OFFICe AUG 2~ 2011 COIM.fUNITY CARE LICENSING Certificate of Completion I State of California- Department of Justice- Kamala D. Harris. .. Page 2 of2 http://oag.ca.gov/ethics/verififation 3/5/2014 / STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 05/31/2011 CHILDREN'S COTIAGE- PRESCHOOL 283005477 1078 EAST AVE NAPA, CA 94559 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 05/23/2011 , have been cleared: Section Cited: 101229.1(a) Plan of Correction: I will notify parents and send a copy of notification to CCL by 5/3 1/11 . LICENSING EVALUATOR NAME: Susan Keehn Date Due: 05/31 /2011 Corrections: copy of note to parents received . Clearance Date: 05/31/2011 TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page : 1 of 1 I CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENC Y CCLD Regional Office 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 05/31 /2011 CHILDREN'S COTTAGE CHILD CARE, INC. - INFANT 283007874 1078 EAST AV NAPA, CA 94559 Letter of Deficiency Citations Cleared Dear Licensee , The following deficiencies , initially cited during a visit on 05/23/2011, have been cleared : Section Cited: 101416.2(b) Plan of Correction : I now understand I must read the entire deficiency and make the Date Due: 05/31 /20 11 Correcti ons: a request for exception is received . Clearance Date: 05/31/201 1 Section Cited: 101229. 1(a) Plan of Correction : I will notify parents and send a copy of notification to CCL by 5/31 /11 . Date Due : 05/31/20 11 Corrections : copy of note to parents received Clearance Date: 05/3 1/2011 Section Cited: 101439(b) Plan of Correction : I will replace the quilt. I will notify CCL when this is done -no later than 5/31 /11 . Date Due: 05/31/2011 Corrections : A receipt for new quilt and waterproof fitted matress cover is received . correction by the due date. I understand that if plans of correction are not cleared, a civil penalty may apply. I wi ll request an exception for the teacher in question . LICENSING EVALUATOR NAME: Susan Keehn Clearance Date: 05/31/201 1 TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: 0P DATE: 05/31 /2011 Th is report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 I CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CCLD Regional Office 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 01/10/2011 CHILDREN'S COTIAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 01 /03/2011 , have been cleared : Section Cited: 101226.3 Plan of Correction : If a child discloses an unusual statement to a teacher. the teacher will follow up by questioning the child and report to the director and parents if appropriate. especially if an injury is involved. Training will be provided to the lead teacher today. who will verbally alert all staff. Formal training will be conducted by the end of Section Cited: 101229 (a)(1) Plan of Correction: Children will be visually supervised when going to the bathroom by a teacher or an aide and the office will be called if necessary. Tra ining will be provided to the lead teacher today. who will verbally alert all staff. Formal training will be conducted by the end of the week . I will submit a summary of this training along with a list of all staff in attendance. Section Cited: 101229(a) Plan of Correction : See above. Date Due : 01/04/2011 Corrections : Rec'd written policy on above date Date Due: 01 /04/2011 Corrections : Rec'd written policy on bathroom supervision on above date . Date Due: 01 /04/2011 Corrections: Rec'd written policy on above date. LICENSING EVALUATOR NAME: Terri Jensen Clearance Date : 12/31 /20 10 Clearance Date : 01 /07/2011 Clearance Date: 01 /07/2011 TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE: ~~~ DATE: 01/10/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 I STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office 101 GOLF COURSE DR. STE. A-230 ROH NERT PARK, CA 94928 01/10/2011 CHILDREN'S COTIAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee , The fo llowing deficiencies , in itially cited during a visit on 01 /03/2011 , have been clea red: Section Cited : 101206(1)(c) Plan of Correction: Prior to making a plan of correction. I would like to examine the signatures in question . I do not understand how this happened. CS Jensen will FAX or scan 226-8118 copies of LIC 9224 . ray@children's cottage .com LICENSING EVALUATOR NAME : Terri Jensen Date Due: 01 /07/2011 Corrections : Rec'd written policy for obtaining signatures and filing these forms , on above date. Clearance Date: 01 /07/2011 TELEPHONE : (707 ) 494-8334 LICENSING EVALUATOR SIGNATURE: \ DATE: 01 / 10/2011 Th is report must be available at Child Care and Group Home facilities for public review for 3 years . Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 r--- \ \\i I l rt--~ - CDSS !"- STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 101 GOLF COURSE DR. STE . A-230 JOHN A WII.GNER i . IR! ·::iOI< ROHNERT PARK , CA 94928 EDM UND G. BROWN JR GO'.'ERNCR January 20 , 2011 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 1078 EAST AVE NAPA CA 94559 Dear Mr. Welch , I am in receipt of your letter dated 1/13/11 wherein you state you no longer live on Crystal Court in Napa and so you are changing both the facility and the licensee mailing address to be the same as the facility address , 1078 East Ave. Napa . Normally, when the mailing address changes , this is a change that is accomplished by updating the application form . Because you put this in writing , I have changed the address in our system . Whenever the applicant/licensee moves or changes phone number, etc. we need to update this information on the LIC 215 , Applicant information . Please send updated LIC 215 for yourself and Mary, if Mary's information has changed as well . Sincerely, )I~ Susan Keehn Licensing Program Analyst (707) 588-5056 licensee/fac ility m ai ling address Letter (FAS ) - (11/08) r---..... r r-- hlo~ ~~ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORN IA DEPARTMENT OF SOCIAL SERVICE COMMUNITY CARE LICENSING DIVISION RECEIPT NO: DATE ISSUED: OFFICE: CASH STATE RECEIPT FOR FEE TYPE PAID: CIVIL PENALTY THESE FEES ARE NON-REFUNDABLE FACILITY NUMBER REMITIER PCA PAY TYPE DATE OF CHECK CHECK NUMBER TOTAL AMOUNT COLLECTED 283005477 Childrens Cottage Child Care 84035 Check 10/28/2010 4651 $150.00 R01-000181205 10/28/2010 01 "' ,-.. ..,......... h~~ ~scvvv STATE OF CALIFORN IA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICE COMMUNITY CARE LICENSING DIVISION RECEI PT NO: DATE ISSUED: OFFICE: CASH STATE RECEIPT FOR FEE TYPE PAID: CIVIL PENALTY THESE FEES ARE NON-REFUNDABLE FACILITY NUMBER REMITIER PCA PAY TYPE DATE OF CHECK CHECK NUMBER TOTAL AMOUNT COLLECTED 283005477 Childrens Cottage Child Care 84035 Check 10/28/2010 4651 $150.00 R01-000181205 10/28/2010 01 ,r-- ~- ((~ /"'"' STATE OF CALIFORNIA- HEALTH AND HUM AN SERVICES AGENC~ CALIFORNIA DEPARTMENT OF SOCIAL SERVICES NOTICE OF CIVIL PENALTIES DUE ~ Initial Invoice INVOICE l Final Notice N0._01_0_14_8_8_ _ _ _ _ _ _ __ DISTRICT OFFICE NUMBER 01 - - ----- ~-FACiLITY NAME FISCAL YEAR Childrens Cottage-Preschool 10/11 FACILITY ADDRESS FACILITY TYPE 1078 East Ave CCC ICITY 1 STATE CA Napa LICENSEE(S) DATE LIC 422 SENl I 10/19/10 PENALTY PCA CODE 84035 -I ZIP CODE 94559 OR UNLICEN.SED FACILITY OPERATOR FACILITY NUMBER r283005477 Children's Cottage Child Care, Inc. ADDRESS 3382 Crystal Court CITY STATE Napa CA ZIP CODE 94558 The California Health and Safety Code, Sections 1548, 1568.0822 , 1569.49, 1596.99 , and 1597.62 provides fo r the imposition of civil penalties against any facility which fails to take corrective action within prescribed time periods. The California Health and Safety Code, Sections 1547, 1568.0821 , 1569.485, 1596.89, 1596.891 and 1597.61 provides for the imposition of civil penalties against any unlicensed facility which fails to take corrective action within prescribed time periods. Your facility has been found in violation of Community Care Licensing statutes and regulations. _ _ _ _ _ _ _ _ __ Failure to correct the deficiency(ies) cited on the Licensing Report (LIC 809, 9099) dated_1_0_14_1_1O has resu lted in the following civil penalty assessment of: Penalty Amount Due ..... . . . ..... ... . . . . ... . . .... .. . ... .. ----------------------------150.00 Less Payment(s) Received .. . ... . .. . .. .. ...... ........... . -0- ---------------------------- BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150.00 ---------------------------- Send the enclosed copy of this notice and your payment to the address shown below within 10 days. Make checks payable to the California Department of Social Services. Please write your invoice and facility number on your check. COMMUNITY CARE LICENSING 101 GOLF COURSE DR. , STE A-230 ROHNERT PARK, CA 94928 KIM NAGY 707-588-5026 FAILURE TO PAY MAY RESULT IN ANY OR ALL OF THE FOLLOWING: SMALL CLAIMS COURT ACTION, DENIAL, SUSPENSION OR REVOCATION OF A LICENSE; OR A FRANCHISE TAX BOARD INTERCEPT. LIC 422 (11/00) (PUBLIC) r' r' OIDI '-V6~ STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL 10/04/2010 CITY FACILITY ADDRESS 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties can be assessed against any faci lity which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99 . You are hereby notified that a civil penalty has been assessed. The above facility has been found in violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12, Section(s) 101229a and/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4 , and 3.5 Section(s) A Facility Evaluation Report {LIC 809) was issued on 11/17/2009 giving notice that failure to correct the above violation (s) would result in a civil penalty. 0 a x ~x Because you failed to make the corrections specified on the LIC 809, civil penalty of $0.00 is assessed for the period from through . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed. This will continue until correction(s) are made to comply with the licensing laws, regulations, and approval of the California Department of Social Services or authorized licensing agency. Because you repeated a violation of the same subsection within a 12 month period,an immediate civil penalty of $150.00 is assessed for 10/04/2010, the day the deficiency was cited . 0 x All Facility Types : Second citation within a 12 month period ; an immediate civil pena lty of $150 per violation then $50 per day per violation until corrections are made . O xResidential Care Facility for the Elderly (RCFE) , Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period ; an immediate civil penalty of $1 ,000 per violation then $100 per day per violation until corrections are made. 0 0 x Family Child Care Homes (FCCH) , Child Care Centers (CCC) , Community Care Faci lity (CCF) : Third citation within 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made . x Violations which result in injury, sickness , or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM AN ALYST Susan Keehn SI GNATURE OF LICENSIN G PROGRAM ANALYST ~1~ NAME OF FACILITY REPRESENTATIVE/TITLE Yasmin Solaria SIGNATURE OF FACILITY REPRESENTATIVE ~~~ DATr.-4 9(64/~6 10' Page: 1 ol 2 ~ /'- STATE OF CALIFORNIA· HEALTH AND HU MAN SERVICES AGENC Y CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CC LD Regional Office 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 12/07/2010 CH ILDREN'S COTTAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee , The following deficiencies, initially cited during a visit on 10/14/2010, have been cleared : Section Cited : 101226.3 (b) Plan of Correction : We have a separate file for this incident. I will read the regulation and train staff. I will submit a written summary of my understanding of this regulation . signed by all staff. Date Due: 10/29/2010 Corrections: Received written suymmary on above date. Clearance Date: 10/19/2010 'jqu '( poe lb 'f report} (L~req~I~', Ylfti> 1lJ b~ )"c. -JIJYI-Z_, ~a~ a:lot- inol'6u LICENSING EVALUATOR NAME: Ter~ Fl vcpo~i~ rqwrd~/ 1{10< -fnl.) 1u~ TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE : . \X--C>-LJJ) ·~vl/'\ . DATE: 12/07/2010 9 ""'-- This report must be available at Child Care and Group Home facilities for public review for 3 years . Cleared POC Letter (FAS) • (04/05) Pag e: 1 of 1 0 !""'../' STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY - CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 12/07/2010 CHILDREN'S COTIAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee , The following deficiencies , initially cited during a visit on 10/ 14/2010 , have been cleared : Section Cited : 101226.3 (b) Plan of Correction : We have a separate file for this incident. I will read the regulation and tra1n staff. I will submit a written summary of my understanding of this regulation . signed by all staff. Date Due : 10/29/2010 Corrections : Received written suymmary on above date . LICENSING EVALUATOR NAME: Terri Jensen LICENSING EVALUATOR SIGNATURE : ~- ~ I\ "· '- .,\ \11{7('.J1 ~- I V \_; \ •tr \/l il ('-t-1. 1; 1II''Li~' 'wvj1 ·t1v ~--------~--- / \/1 . . ..~ 1 Clearance Date : 10/19/2010 TELEPHONE : (707) 494-8334 DATE : 12/07/2010 ·-- This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) - (04105) Page: 1 of 1 CG ~( (r}Y---- r !""' STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 06/09/2010 CHILDREN'S COTTAGE CHILD CARE, INC.- INFANT 283007874 1078 EAST AVENUE NAPA, CA 94559 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 05/18/2010, have been cleared: Section Cited: 101239(f)(1) Plan of Correction: I will put a trash can with a tight fitting lid in the room by 5/26/10. Date Due: 05/31/2010 Corrections: picture received. Clearance Date: 05/27/2010 Section Cited: 101220(a) Plan of Correction: I emailed the parent who states she has an appt for early June. I will Date Due: 06/15/2010 Corrections : picture received. Clearance Date: 05/27/2010 Date Due: 05/19/2010 Corrections: Removed during visit. Clearance Date: 05/18/2010 send a copy of the form when received . Section Cited: 101419.2(a) Plan of Correction: These have been removed from the room . t::v sr LICENSING EVALUATOR NAME: Susan Keehn 3 e5 P ll 'IS' TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: Ji~ DATE: 06/09/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page: 1 of 1 r , _,--.. STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 06/09/2010 CHILDREN'S COTTAGE CHILD CARE, INC.- INFANT 283007874 1078 EAST AVENUE NAPA, CA 94559 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 05/18/2010, have been cleared: Section Cited : 101219(f) Plan of Correction: This has been corrected and the password has been removed . I will email a copy of the link tomorrow to show this has been corrected . Section Cited: 101238(a) Plan of Correction: I cleaned the ramp during the visit to clear the violation . LICENSING EVALUATOR NAME: Susan Keehn Date Due : 05/21 /2010 Corrections: LPA checked website and the password had not been removed ; however it was removed after subsequent call to Licensee. Date Due : 05/21 /2010 Corrections: cleaned during visit. Clearance Date: 05/19/2010 Clearance Date: 05/18/2010 TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: )~ DATE: 06/09/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) - (04/05) Page: 1 of 1 0 (' ORIGINAL SIGNED BY SIGNATORY [ill STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CDSS ,....--- 101 GOLF COURSE DR. STE. A-230 JOHNA. WAGNER ROHN ERT PARK, CA 94928 DEPARTMENT OF SOCIAL SERVICES DIRECTOR ARNOLDSCHWARZENEGGER GOVERNOR September 03 , 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A. CA 94558 FIDENTIAL INFORMATION Dear Mr Welch, This letter is in response to your appeal letter received in this licensing office on march 1, 2010. Please accept the Departments apology for the delay in response. I am processing this appeal for LPS Linda Walker. You are appealing a violation that you were made aware of on February 24, 2010. H $ S 1539 regarding alleged retaliation against one of the centers employees for talking to CCL staff. You allege that CDSS has failed to give you an accurate report and that you "do not believe you received an accurate report." I have reviewed the facility file for information specific to your appeal request and reviewed the information submitted by you for consideration . I do not find sufficient evidence to grant your request for appeal. Respectfully, ORIGINIAL SIGNED SENT, FILED THIS DATE. MHERIN Myrtle Herin, Licensing Program Supervisor ORIGINAL SIGNED BY SIGNATORY Appeal Response-Denial LeHer (FAS) - (11 /08) r STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY r ' CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION REDWOOD EMPIRE CC 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 05/19/2010 CHILDREN'S COTIAGE- PRESCHOOL 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 05/18/2010 , have been cleared: Section Cited : 101238.2 d 2 Plan of Correction : POC PROOF OF CORRECTION WI LL BE SENT TO LICENSING 5/192010 UNTIL CORRECTED CHILDREN WILL NOT BE ALLOW ED IN THI S AREA, OR AREA OF HAZARD WI LL BE COVERED.Staff will receive training on the above and proof of correction to licensi ng by May 19th Section Cited: 101238 g Plan of Correction : Cabinet lock will be replaced and secured today so that contents inside are inaccessible to children . Staff will monitor the cabinet lock daily and as needed to ensure the cabinet is locked. Staff will receive training on the above. Proof of correction will be sent to licensing by May 19 2010. lock secured during today's visit 3pm LICENSING EVALUATOR NAME: Barbara Lawler Date Due : 05/11 /2010 Corrections: Clearance Date: Licensing received picture of 05/19/2010 playground showing dirt has been piled over and covers adequately the protruding rebar. POC cleared May 19 2010 Date Due: 05/18/2010 Corrections: cabinet lock was replaced during visit on May 18 2010 POC cleared Clearance Date: 05/18/2010 TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS) • (04/05) Page : 1 of 1 sr~ ,....... -- -k~~ r JF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENC' CALIFORNIA DEPARTMENT OF SOCIAL SEA~- • D'II'StV"'- NOTICE OF CIVIL PENALTIES DUE ~ Initial Invoice :.J INVOICE NO. 0101417 --------- ------------ - FACILITY NAME DISTRICT OFFICE NUMBER _o1_ _ __ FISCAL YEAR Children's Cottage -Preschool 09/10 FACILITY ADDRESS FACILITY TYPE 1078 East Ave CCC CITY Napa Final Notice STATE - CA ------ LICENSEE(S) OR UNLICENSED FACILITY OPERATOR ZIP CODE DATE UC 422 SENT 2/23/10 PENALTY PCA CODE 84035 L-----------~~------------~ 94559 -- . -- L_ 2_83_o_o_5_ 4 7_7__-:_- - - - Children'S Cottage Child Care Inc. ---~ ADDRESS 3382 Crystal Court --- CITY STATE Napa CA ZIP CODE 94558 ----·-------- ---- The California Health and Safety Code, Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.62 provides for the imposition of civi l penalties against any facility which fails to take corrective action within prescribed time periods. The California Health and Safety Code, Sections 1547, 1568.0821 , 1569.485, 1596.89, 1596.891 and 1597.61 provides for the imposition of civil penalties against any unlicensed facility which fails to take corrective action within prescribed time periods. Your facility has been found in violation of Community Care Licensing statutes and regulations. Failure to correct the deficiency(ies) cited on the Licensing Report (LIC 809, 9099) dated_1_2_11_6_10_9____________ has resulted in the following civil penalty assessment of: Penalty Amount Due . .. . .... .. ...... . ...... .. ........ . ... 150.00 --------------Less Payment(s) Received .... . .. . .... .. . ... . . ...... . . . ... -0-- - - - - - - - - - - - - - - - - BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ------------~--150.00 Send the enclosed copy of this notice and your payment to the address shown below within 10 days. Make checks payable to the California Department of Social Services. Please write your invoice and facility number on your check. COMMUNITY CARE LICENSING 101 GOLF COURSE DR., STE A-230 ROHNERT PARK, CA 94928 KIM NAGY 707-588-5026 FAILURE TO PAY MAY RESULT IN ANY OR All OF THE FOLLOWING: SMALL CLAIMS COURT ACTION, DENIAL, SUSPENSION OR REVOCATION OF A LICENSE; OR A FRANCHISE TAX BOARD INTERCEPT. LIC 422(11/00) (PUBLIC) ,-. ,--... oto\L\\rt STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL FACILITY ADDRESS 12/16/2009 CITY 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods , per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed. The above facility has been found in violation of the California Code of Regulations , Title 22 , Divisions 6, and/or 12, Section(s) and/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4, and 3.5 Section(s) 1596.8595(c) A Facility Evaluation Report (LIC 809) was issued on 09/22/2009 giving notice that failure to correct the above violation(s) would result in a civil penalty. Because you failed to make the corrections specified on the LIC 809, a civil penalty of $0.00 is assessed for the through . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed . This will continue until correction(s) are made to comply with the licensing laws, regulations , and approval of the California Department of Social Services or authorized licensing agency. D x period from C8J x Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for 12/16/2009, the day the deficiency was cited. D x All Facility Types: Second citation within a 12 month period ; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. D x Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period; an immediate civil penalty of $1 ,000 per violation then $100 per day per violation until corrections are made. D x Family Child Care Homes (FCCH), Child Care Centers (CCC) , Community Care Facility (CCF): Third citation within 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. 0 x Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROG RAM ANALYST Susan Keehn SIGNATURE OF LICENSING PROGRAM ANALYST -; Ray Welch DATE 12/16/2009 TITLE Linda Walker Page : 1 of 2 / r ~ ORIGINAL SIGNED BY SIGNATORY [ill STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CDSS ,.----.. 101 GOLF COURSE DR. STE. A-230 JOHN A. WAGNER ROHNERT PARK, CA 94928 DEPARTMENT OF SOCIAL SERVICES OIRlC. TOR ARNOLD SCHWARZENEGGER GO VERNOR January 05, 2010 'CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Dear Ray Welch : Per your request to appeal the citation issued on September 22, 2009 of which was received in the Rohnert Park Local Unit Office on October 7, 2009, a review was made of the following deficiency and/or penalty notices : Responsib ility for Providing Care and Supervision Section 101229(a)(1 ). The results are as follows : [x] [ ] [ ] [ ] [ ] Penalty Assessment/Deficiency Dism issed Penalty Assessment Amount amended to $ _ _ Extension of Correction Due Date Approved to _ __ Extension Date Denied Request Denied Upon further review of this citation, it appears as though adequate supervision was provided for by staff to the child to meet their needs, and, that the Center's staff was in close enough proximity to also provide "audio supervision" while retrieving clean clothes. In add ition , the staff also appeared to be sensitive to affording the child dignity in their personal rights during this exchange. Based upon this , the citation will be dismissed. An amended copy of this report will be mailed to you. Sincerely, Linda Walker Licensing Program Manager ORIGINAL SIGNED BY SIGNATORY Appeal Letter Letter (FAS) - (11/08) r /"""' STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL FACILITY ADDRESS 12/16/2009 CITY 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods , per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99 . You are hereby notified that a civil penalty has been assessed. The above facility has been found in violation of the California Code of Regulations , Title 22, Divisions 6, and/o r 12, Section(s) and/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4 , and 3.5 Section(s) 1596.8595(c) A Facility Evaluation Report (LIC 809) was issued on 09/22/2009 giving notice that failure to correct the above violation(s) would result in a civil penalty. Beca use you fai led to make·the corrections specified on the LIC 809, a civil penalty of $0.00 is assessed for the D x period from through . D x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed . This will continue until correction(s) are made to comply with the licensing laws, regulations, and approval of the California Departme nt of Social Services or authorized licensing agency. ~x Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for 12/16/2009, the day the deficiency was cited. D x All Facility Types: Second citation within a 12 month period ; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made . D x Residential Care Facility for the Elderly (RCFE) , Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period ; an immediate civil pe nalty of $1 ,000 per violation then $100 per day per violation until co rrections are made. 0 0 x x Family Child Care Homes (FCCH), Child Care Centers (CCC} , Community Care Facility (CCF) : Third citation within 12 month period ; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made . YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Susan Keehn SIGNATURE OF LICENSING PROGRAM ANALYST X~ 1!o oJh /?/\ } , 'S/I 0 '-{I /I'\JOe. f}'>t fk./,) {0 ./{;v'- '( iA_ Q..-L/ lf. 't \>-.- J2 lAP{ . ~~l(_ oONLY} DATE 12/16/2009 TITLE Linda Walker J \__ I_ •L '' \_ \..___ Page : 1 of 2 r ,/ STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL FACILITY ADDRESS 12/09/2009 CITY 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 28300~7 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods , per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed . The above facility has been found in violation of the California Code of Regulations , Title 22, Divisions 6, and/or 12, Section(s) and/or California Health and Safety Code , Chapters 3, 3.01, 3.2, 3.4, and 3.5 Section(s) H&S1596.H&S1596.1596.8595c A Facility Evaluation Report (LIC 809) was issued on 09/22/2009 giving notice that failure to correct the above violation(s) would result in a civil penalty. 0 x ~x Because you failed to make the corrections specified on the LIC 809, a civil penalty of $0.00 is assessed for the period from through . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed. This will continue until correction(s) are made to comply with the licensing laws. regulations , and approval of the California Department of Social Services or authorized licensing agency. Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for 12/09/2009, the day the deficiency was cited . 0 x All Facility Types: Second citation within a 12 month period; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. 0 x Residential Care Facility for the Elderly (RCFE) , Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period; an immediate civil penalty of $1,000 per violation then $100 per day per violation until corrections are made. 0 0 x Family Child Care Homes (FCCH), Child Care Centers (CCC), Community Care Facility (CCF): Third citation within 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. x Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Susan Keehn SIGNATURE OF LICENSING PROGRAM ANALYST J NAME OF FACILITY REPRESENTATIVE/TITLE SIGNATURE OF FACILITY REPRESENTATIVE SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 12/09/2009 TITLE LIC421 (FAS) - (05/06) Page : 1 of 2 r !'""· STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL FACILITY ADDRESS 11/17/2009 CITY 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 283005~1 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed. The above facility has been found in violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12, Section(s) and/or California Health and Safety Code, Chapters 3, 3.01, 3.2, 3.4, and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 11/17/2009 giving notice that failure to correct the above violation(s) would result in a civil penalty. 0 Because you failed to make the corrections specified on the LIC 809, a civil penalty of $0.00 is assessed for the from through . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed. This will continue until correction(s) are made to comply with the licensing laws, regulations , and approval of the California Department of Social Services or authorized licensing agency. x period (2J x Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for 11/17/2009, the day the deficiency was cited. x All Facility Types: Second citation within a 12 month period; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. 0 0 x 0 x Residential Care Facility for the Elderly (RCFE) , Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period; an immediate civil penalty of $1,000 per violation then $100 per day per violation until corrections are made. 0 x Family Child Care Homes (FCCH), Child Care Centers (CCC), Community Care Facility (CCF): Third citation within 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Terri Jensen SIGNATURE OF LICENSING PROGRAM ANALYST NAME OF FACILITY REPRESENTATIVE/TITLE SIGNATURE OF FACILITY REPRESENTATIVE SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 11/17/2009 TITLE LIC421 (FAS) • (05/06) Page: 1 of 2 ,.- /"" STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL FACILITY ADDRESS 01/28/2009 CITY 1078 EAST AVENUE STATE NAPA ZIP CODE CA LICENSEE(S)/OPERATOR 94559 FACILITY NUMBER WELCH , MARY 283005:.4-7-1 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed. The above facility has been found in violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12, Section(s) 101161 and/or California Health and Safety Code, Chapters 3, 3.01, 3.2 , 3.4, and 3.5 Section(s) A Facility Evaluation Report {LIC 809) was issued on 01/28/2009 giving notice that failure to correct the above violation(s) wou ld result in a civil penalty. 0 Because you failed to make the corrections specified on the LIC 809, a civil pena lty of $0.00 is assessed for the x period from through . 0 x 0 x x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed . This will continue until correction(s) are made to comply with the licensing laws, regulations, and approval of the California Department of Social Services or authorized licensing agency. Because you repeated a violation of the same subsection within a 12 month period,an immediate civil penalty of $150.00 is assessed for 01/28/2009, the day the deficiency was cited. ~ x All Facility Types: Second citation within a 12 month period; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. 0 x Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period; an immediate civil penalty of $1,000 per violation then $100 per day per violation until corrections are made. 0 x Family Child Care Homes (FCCH), Child Care Centers (CCC) , Community Care Facility (CCF): Third citation within 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Iris Hidalgo SIGNATURE OF LICENSING PROGRAM ANALYST ~~~ NAME OF FACILITY REPRESENTATIVE/TITLE SIGNATURE OF FACILITY REPRESENTATIVE ~~~ SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 01 /28/ 2009 TITLE LIC421 (FAS) • (05/06) Page: 1 of 2 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCJ CALIFORNIA DEPARTMENT OF SOCIAL SERVICES NOTICE OF CIVIL PENALTIES DUE ~ Initial Invoice INVOICE N0. _01_0_13_5_4 _ __ _ _ _ _ __ I FACILITY NAME- -- 1 r J Final Notice - -- DISTRICT OFFICE NUMBER 01 ----- -- FISCAL YEAR Children's Cottage-Preschool 08/09 FACILITY ADDRESS [ 1078 East Avenue CITY STATE LNap~ --- CA ZIP CODE ;C~I~ TYPE ------- r·DATE LIC 422 SENT 8/11/09 PENALTY PC A CODE l 84035 94559 LICENSEE(S) OR UNLI CENSED FACILITY OPERATOR FACILITY NUMBER IChildren's Cottage Child Care Inc. 283005477 ADDRESS Court !3382-Crystaj ---- ----------CITY Napa STATE -- ZIP CODE CA 94558 ------- The California Health and Safety Code, Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.62 provides for the imposition of civil penalties against any facility which fails to take corrective action within prescribed time periods. The Californ ia Health and Safety Code, Sections 1547 , 1568.0821 , 1569.485, 1596.89, 1596.891 and 1597.61 provides for the imposition of civil penalties against any unlicensed facility which fails to take corrective action within prescribed time periods. Your facility has been found in violation of Community Care Licensing statutes and regulations . Failure to correct the deficiency(ies) cited on the Licensing Report (LIC 809, 9099) dated_1_12_8_1_ 09_ _ _ _ _ _ _ _ __ has resulted in the following civil penalty assessment of: 50.00 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Penalty Amount Due ..... . . . . .. . .. .... . .... . .. ... ...... .. _ -0-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Less Payment(s) Received . . . . ... . . . . .. . .... . ... . ..... . ... _ BALANCE DUE . ..... . . . .. . . .. . . .. . .. .. .. . .. . . . . ... .. ... _5_0_ .0_0_ _ _ _ _ _ _ _ _ _ _ _ __ Send the enclosed copy of this notice and your payment to the address shown below within 10 days. Make checks payable to the California Department of Social Services. Pl ease write your invoice and facility number on your check. COMMUNITY CARE LICENSING 101 GOLF COURSE DR., STE A-230 ROHNERT PARK, CA 94928 KIM NAGY 707-588-5026 FAILURE TO PAY MAY RESULT IN ANY OR All OF THE FOLLOWING: SMALL CLAIMS COURT ACTION, DENIAL, SUSPENSION OR REVOCATION OF A LICENSE; OR A FRANCHISE TAX BOARD INTERCEPT. LIC 422 (1 1100) (PUBLIC) STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENAL TV ASSESSMENT REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 DATE FACILITY NAME CHILDREN'S COTTAGE- PRESCHOOL 01/28/2009 CITY FACILITY ADDRESS 1078 EAST AVENUE NAPA ZIP CODE STATE CA 94559 FACILITY NUMBER LICENSEE(S)/OPERATOR WELCH, MARY 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822 , 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed . The above facility has been found in violation of the California Code of Regulations , Title 22, Divisions 6, and/or 12, Section(s) 101238(a) and/or California Health and Safety Code, Chapters 3, 3.01 , 3.2, 3.4, and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 01/14/2009 giving notice that failure to correct the above violation(s) would result in a civil penalty. Because you failed to make the corrections specified on the LIC 809, a civil penalty of $50.00 is assessed for the IZI x period from 01/28/2009 through 01/28/2009. · 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed . This will continue until correction(s) are made to comply with the licensing laws , regulations , and approval of the California Department of Social Services or authorized licensing agency. 0 0 x Because you repeated a violation of the same subsection within a 12 month period,an immediate civil penalty of $0.00 is assessed for, the day the deficiency was cited . 0 x All Facility Types : Second citation within a 12 month period ; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. 0 x Residential 0 x Family Care Facility for the Elderly (RCFE) , Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period ; an immediate civil penalty of $1,000 per violation then $100 per day per violation until corrections are made. Child Care Homes (FCCH), Child Care Centers (CCC), Community Care Facility (CCF): Third citation within 12 month period ; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. x Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until.!=orrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Iris Hidalgo SIGNATURE OF LICENSING PROGRAM ANALYST NAME OF FACILITY REPRESENTATIVEfTITLE SIGNATURE OF FACILITY REPRESENTATIVE TITLE L!JM Pago: 1 of 2 -......./ ORIGINAL SIGNED BY SIGNATORY D1J STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES CDSS ,.---- 101 GOLF COURSE DR. STE. A-230 JOKN A . WAGNER DIRECTOR ROHNERT PARK, CA 94928 ARNOL D SCHWARZENEGGER GOVERNOR January 04, 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A. CA 94558 Mr. Welch: SUBJECT: California Public Records Act Request Per your recent Public Records Act Request, attached is a list of the facilities that Terri Jensen visited between January 1, 2009 and December 12, 2009 and issued Type A deficiencies. As I am sure you realize,! public files related to these facilities( some of which have been licensed for years) are truly voluminous . Please have the copying service you retain contact our Rohnert Park Local Unit Office at (707) 588-5026 for an appointment to begin copying the files . Sincerely, Linda Walker Licensing Program Manager c: Linda Kyrla, Regional Manager Francine Kammeyer, Senior Staff Counsel ORIGINAL SIGNED BY SIGNATORY CPRA Letter (FAS) • (11 /08) ~ CDSS - STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 10 1 GOL F COURSE DR. STE . A-230 JOHN A. WA GNER D HlC TOR ROH NERT PARK, CA 94928 AR NOLD SCHWARZE NEGG ER GOVERNOR January 29 , 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A, CA 94558 Dear Mr. Welch : SUBJECT: California Public Records Act Request Per your recent Publics Records Act Request, attached is a list of the facilities that have received Type A violations and/ or civil penalties from the Rohnert Park office in 2009. In add ition , the following information you requested can be obtained regarding the names of directors or licensees, and the addresses and telephone numbers on our website at www.ccld.ca .gov. Once on the website click on "Find Licensed Care". In this screen the information requested can be retrieved . ~J7.vft~ Linda Walker Licensing Program Manager C: Linda Kyrla , Regional Manager Darryl East, Ass ist. Chief Counsel California Public Rec o rd s Act Request Letter (FAS ) - (11108) !]] STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGENCY CDSS 101 GOLF COURSE DR. STE. A-230 JOHN A WAGN ER ROHNERT PARK, CA 94928 - Di~ L ~ DEPARTMENT OF SOCIAL SERVICES A RNOLD SCHWARZEN EGGER G~'•/E~ OR · o~ ~ January 22, 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAP A, CA 94558 Dear Mr. Welch : I am in receipt of your appeal received in our office December 24, 2009 requested to dismiss the citations issued on 12/16/09. I have spoken to Ms . Keehn and reviewed the issues involving complaint# 01-CC-20090728151400 received in our office on 7/28/09 regarding personal rights; Section (1012290(a)(1) and Section(101223(a)(2); lack of supervision issues at the Lincoln Ave facility. I have also read your appeal letter and letters submitted from two of your parents, thank you for including them . _ In your appeal letter you state that the citation you received on 12/16/09 was the same as one issued to you on 7/28/09. A review of our records doesn't show any citations issued to you on 7/28/09. Ms. Keehn did visit your faci lity on 8/5/09 and during that visit she gave you a LIC 9099 opening the complaint stating further investigation would be needed and gave you a LIC 809 for a case management visit which included citations. Ms . Keehn conducted a complete and thorough investigation regarding the allegations involving the complaint and concluded that the faci lity failed to provide supervision necessary to meet a child's needs as a child had bitten others many times and that more than one child had been bitten _The allegation was substantiated and an appropriate citation was issued to you in the report dated 12/16/09. This was not a duplicate citation. It is true that you closed your facility at Lincoln Ave in October, however, since the complaint came in prior to the closure it was appropriate for Ms . Keehn to conclude the complaint that was received in our office prior to you closing the facility . In regards to dismissing H&S Section 1596.8595 relating the AB 633. Interviews with parents stated that they did not receive copies of some of the reports as well as the non compliance conference documents . In add ition , this is a repeat violation that has occurred within the year. Based on th is the citation is upheld. ~~ Licensing Program Manager ORIGINAL SIGNED BY SIGNATORY []j STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CDSS 101 GOLF COURSE DR. STE. A-230 JOHN A . WAGNER DIRECTOR ROHNERT PARK, CA 94928 - DEPARTMENT OF SOCIAL SERVICES ARNOLD SCHWARZENEGGER GOVERNOR January 14, 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Dear Mr. Welch : SUBJECT: California Public Records Act Request The California Department of Social Services (CDSS) Chico Regional Office, Rohnert Park Local Unit Office is responding to your California Public Records Act (CPRA) request received January 12, 2010. CDSS will promptly initiate an inquiry into the existence and feasibility of gathering disclosable public records responsive to your request. When the records responsive to your request are identified , you will be notified. Due to severe budgetary and staffing constraints, the Rohnert Park office is unable to actually copy the documents for you . You may of course retain a private copying service. If you do so, please have that service make an appointment to copy the public records. If you have any questions or require further assistance in this matter, please contact me at (707) 588-5034. Sincerely, Linda Walker Licensing Program Manager c: Linda Kyrla, Regional Manager Francine Kammeyer, Senior Staff Counsel ORIGINAL SIGNED BY SIGNATORY CPRA Letter Letter (FAS) • (11/08) ORIGINAL SIGNED BY SIGNATORY [ill STATE OF CALIFORNIA- HEALTH AND HUMAN SERVIC ES AGENCY CDSS 101 GO LF COURSE DR. STE . A-230 JOliN A. WAGNER DIRECTOR ROHNERT PARK, CA 94928 ---- DEPARTMENT OF SOCIAL SERVICES ARNOLDSCHWARZENEGGER GOVER NOR January 05, 2010 CHILDREN'S COTTAGE- PRESCHOOL- 283005477 3382 CRYSTAL COURT NAPA, CA 94558 Dear Ray Welch : Per your request to appeal the citation issued on September 22 , 2009 of which was received in the Rohnert Park Local Unit Office on October 7, 2009, a review was made of the following deficiency and/or penalty notices: Responsibility for Providing Care and Supervision Section 101229(a)(1 ). The results are as follows : [ x] [ ] [ ] [ ] [ ] Penalty Assessment/Deficiency Dismissed Penalty Assessment Amount amended to $ _ _ Extension of Correction Due Date Approved to _ __ Extension Date Denied Request Denied Upon further review of this citation , it appears as though adequate supervision was provided for by staff to the child to meet their needs , and , that the Center's staff was in close enough proximity to also provide "audio supervision" while retrieving clean clothes. In addition , the staff also appeared to be sensitive to affording the child dignity in their personal rights during this exchange . Based upon this , the citation will be dism issed . An amended copy of this report will be mailed to you . Sincerely, Linda Walker Licensing Program Manager ORIGINAL SIGNED BY SIGNATORY Appea l Letter Letter (FAS) • (11 /08) ,.--.-. r- STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR: YASMIN SOLORIO-VALLEJO ADDRESS : 1078 EAST AVENUE CITY: NAPA STATE: CA CENSUS: 20 64 CAPACITY: UNANNOUNCED TYPE OF VISIT: Annual/Required Yasmin MET WITH : 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: 283005477 850 (707) 224-3825 94559 05/29/2013 DATE: TIME BEGAN: TIME COMPLETED: 12:45 PM 04:40PM NARRATIVE LPA Barbara Lawler made today's annual required visit and inspected all outdoor play areas, preschool classrooms and food preparation area . All staff have the required criminal background clearances . Site has working telephone. At least one teacher has current EMSA pediatric CPR and First Aid. LPA reviewed staff and ch ildren's files , sign in and out sheets and required postings. LPA observed Rebecca supervising 12 napping children in the Butterflies classroom . Two teachers were supervising 8 napping children in the Ladybug's room . Ratios and capacity are in compliance . Bathrooms were inspected . Bathrooms , toilets and hand washing sinks are operational , clean and sanitary. Hot water has been turned off. Drinking water is available to children at child size sinks with disposable cups . Outdoor play yard has water fountains . AM and PM snacks are provided . Food preparation area is clean , sanitary, garbage can has tight fitting lid. Toxins are stored inaccessible to food preparation area. Knives , medicines , sharp objects and toiletries are stored in accessible to children. Fully charged 2A 1OBC fire extinguishers are mounted on classroom wa lls Yasmin states there are no poisons weapons or ammunition on the premises. Staff use walkie talkies to communicate . Bathrooms were observed clean and sanitary. Director's office is used to isolate an ill child . Staff restroom next to office is used for a child who becomes ill wh ile in care. Napping mats, and linens are provided by center, an d washed weekly or as needed . Mats are stored appropriately. Ventilation and lighting are comfortable through out the facility. Furnishings, equipment, toys and activities are age and developmentally appropriate, found in safe condition . Outdoor play yard is fully fenced. Yasmin states the sand box is sanitized using vinegar once a week . Climbing structures are cush ioned by adequate amounts of chipped bark. See following lie 809D for violations . Notice of Site Visit and TYPE A violations/licensing reports to be posted for 30 days . LPA discussed appeal rights and lie 9224, Parent's Acknowledgement of Receipt of TYPE A Licensing Reports SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: {j~ l)/{flm!AI_ DATE: 05/29/2013 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC809 (FAS) - (06/04) Page: 1 of 3 ,-.. ,..-... STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 05/30/2013 Section Cited 101238 (a) FACILITY NUMBER: 283005477 VISIT DATE: 05/29/2013 DEFICIENCIES 1 2 3 4 5 6 7 Laundry room with detergents was open and accessible to children, next to storage room used for mats. Hook and eye lock was observed broken . a) The child care center shall be clean , safe, sanitary and in good repair at all times to ensure the safety and well-being of children , employees and visitors . PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 1 1 2 3 4 5 6 7 2 3 4 5 6 7 1 1 2 2 3 3 4 4 5 5 6 6 7 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Laundry room door will be made inaccessible to children . A picture of showing this will be sent to licenisng by close of business by May 30th children will not be allowed in these areas . Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2013 rstand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURt:: DATE: 05/29/2013 This Notice must be posted for 30 days LIC809 (FAS) • (06/04) Page: 2 of 3 ,..-- ,..-- STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 05/29/2013 Section Cited 101227 (6) FACILITY NUMBER: 283005477 VISIT DATE: 05/29/2013 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 7 AM and PM snack menu is not posted for parent's view. (6) Menus shall be in writing and shall be posted at least one week in advance in an area accessible for review by the child 's authorized representative . Copies of the menus as served shall be dated and kept on file for at least 30 days. Menus shall be made available for review by the chi ld's authorized representative and the Department upon request. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 1 2 3 4 1 2 Snack menus will be posted in preschool classrooms by opening of business May 30th . I will notify licensing by telephone call May 30th . We will offer children foods as listed on posted menu . 3 4 5 6 7 3 4 5 5 6 7 6 7 1 2 1 2 3 3 4 4 5 5 6 7 6 7 ---- Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: _ /&:2~- ~{t<.J ~,~ DATE: 05/29/2013 this Form (this and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: :;4~lu~ LIC809 (FAS) - (06/04) DATE: 05/29/2013 Page : 3 of 3 ,......._ r- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 12/10/2012 and conducted by Evaluator Barbara Lawler PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20121210111455 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR : YASMIN SOLOR IO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 17 UNANNOUNCED Yasmin MET WITH : FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 12/18/2012 01 :30PM 06:30PM ALLEGATION(S): 1 Physical plant- outdoor area/play yard was not clean- littered with leaves I 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA's Barbara Lawler and Leticia Meza made today's visit and inspected the facility. At the time of arrival 2 children were napping in preschool classrooms . LPA's met with the director after children awakend from naps 3 and discussed the above allegations. 4 Outdoor areas of the preschool were inspected today. LPA observed walkways and play yard free of debris 5 and leaves. Two staff were interviewed and state that child care staff routinely sweep leaves and debris from 6 ch ildren's walkways , play yard , daily or as needed . A maintenance company blows debris and leaves weekly . 7 8 Although the allegation may be val id, there is not a preponderance of the evidence to prove that the alleged 9 violation occurred. 10 11 NOTICE OF SITE VISIT POSTED 12 13 Inconclusive SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Barbara Lawler Estimated Days of Completion: 0 TELEPHONE: (707) 588-5026 TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: ~~~~~-~ DATE: 12/18/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: "!J~ DATE: 12/18/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04) Page: 3 of 3 r- !"'"' STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Ofllce, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visiUinvestigation of a complaint received in our office on 12/10/2012 and conducted by Evaluator Barbara Lawler COMPLAINT CONTROL NUMBER: 01-CC-20121210111455 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: YASMIN SOLORIO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 17 MET WITH: Yasmin Solorio-Vallejo FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 12/18/2012 01 :30PM 05:45PM ALLEGATION(S) : 1 Personal Rights 2 Children were made to take off shoes prior to going into classroom from the play yard. They had to walk 3 barefoot on cold , wet, concrete that was slippery with wet leaves. 4 Physical Plant 5 Nail or sharp object was sticking out by children's sink in the classroom 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA's Barbara Lawler and Leticia Meza made today's visit and discussed the allegation with center director, 2 Yasmin . LPA's visited both preschool classrooms . Staff interveiwed state that the children attending the Lady 3 Bugs classroom line up outside the classroom , waiting there turn to remove their shoes and socks before 4 entering their classroom . Director states this has been the policy for Lady Bugs classroom , so that excessive 5 dirt from the adjacent play yard is not tracked into classroom . LPA's observed that the Lady Bugs classroom 6 has linoleum flooring at the entrance of both doors, before the carpeting begins. The older PS classroom also 7 has linoleum flooring at the entry way of the classroom. Children attending the Dragon Flys and Butterflys 8 classroom do not follow this practice. These older preschool students enter the classroom, going directly to 9 their cubbies and remove their shoes and socks inside.Young preschool children have waited outside in cold 10 weather, waiting their turn to remove their shoes and socks, walking across wet concrete, before going inside 11 to the classroom . LPA's inspected Lady Bugs classroom and observed a sharp object protruding from the 12 wooden trim, around the children's sink. Both allegations are valid . The preponderance of evidence standard 13 has been met. See following lie 9099D for violation : Appeal rights discussed. Notice of Site Visit and TYPE A licensing reports to be posted for 30 days. The facility is required to provide copies of all TYPE A licensing reports, to the parenUguardian by the next day child is in care. ParenUguardian of newly enrolled families are to receive copies of all TYPE A licensing reports during the next twelve months from the facility representative . Parents are all required to sign lie 9224 Parent's Acknowledgment of Receipt of Licensing reports , and lie 9224 is to be maintained in each child's file. Estimated Days of Completion: 0 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: ~~Wlk~~-- DATE: 12/18/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2012 r-- /""' This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page : 1 of 3 r-- /"'"""' STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE: 12/18/2012 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number PLAN OF CORRECTIONS(POCs) DEFICIENCIES Type A 12/18/2012 Section Cited 101239 (a)(2) 1 2 3 4 5 6 7 Type A 12/18/2012 Section Cited 101238 1 Sharp objecUor nail was observed protruding from 2 the wooden trim on the side of children's hand 3 washing sink. 4 5 6 7 1 Sharp object will be removed before child care 2 resumes Dec 19 2012 . I will send picture of 3 correction to licensing Dec 19 2012. 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Children were required to wait outside in the cold , removing their shoes and socks, before entering classroom . (2) Each child shall be accorded safe , healthful and comfortable accommodations, furnishings and equipment. 1 2 3 4 5 6 7 Effective today all children will enter their classroom wearing their shoes. If necessary the child/children will remove their shoes and socks while inside the classroom and on the linoleum flooring. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: ~IL, id~ A.,~;> DATE: 12/18/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received_ FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2012 This Notice must be posted for 30 days LIC9099 (FAS)- (06104) Page: 3 of 3 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of 3 r-- (' All POC Have Been Cleared STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CLEARED DEFICIENCIES CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGEPRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 12/18/2012 POC Due Date I Section Number 12/18/2012 101239 (a)(2) 12/18/2012 Section Cited 101238 Date Cleared I Comments PLAN OF CORRECTIONS(POCs) 1 ~ ~Effective today all ch ildren will enter their classroom wearing 4 heir shoes . If necessary the child/children will remove the ir 5 shoes and socks while inside the classroom and on the 6 linoleum flooring . 7 12/19/2012 21children will remove shoes and socks 3 while inside the classroom . 4 1 2 3 ~harp object will be removed before child care resumes Dec 4 19 2012 . I will send picture of correction to licensing Dec 19 5 012 . 6 ~I 3 4 7 Section Cited 1 12 3 4 5 6 1 2 3 4 7 Section Cited 1 12 3 4 5 6 7 1 2 3 4 12/19/2012 Sharp object has been removed . r- ,r--. STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:YASMIN SOLORIO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CENSUS: 17 CAPACITY: 64 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH : Yasmin FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 12/18/2012 01 :30PM 06:30PM NARRATIVE 1 LPA's Barbara Lawler and Leticia Meza were at this combination infant and preschool facility today's visit on 2 another matter. During today's visit Title 22 violations were observed . 3 4 5 6 7 8 see following lie 809D 9 10 Notice of Site Visit Posted for 30 days 11 12 Appeal rights were discussed. 13 14 15 The facility is required to provide copies of all TYPE A licensing reports , to the parenUguardian by the next 16 day child is in care . ParenUguardian of newly enrolled families are to receive copies of all TYPE A licensing 17 reports during the next twelve months from the facility representative . Parents are all required to sign lie 9224 18 Parent's Acknowledgment of Receipt of Licensing reports , and lie 9224 is to be maintained in each child's file . 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 I LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: M~~ ~ ~-fl';,J DATE: 12/18/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: 1#~~ DATE: 12/18/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page: 1 of 2 ,-... r'- STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN 'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 12/1 8/2012 Section Cited 101238 FACILITY NUMBER : 283005477 VISIT DATE : 12/18/2012 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Preschool classroom was observed with a multi 1 tiered metal shelf hanging from the wall . Children 2 have access to this area . The shelf was only secured with two 4 " nails", observed pulled away 3 4 from the wall. Upon closer inspection LPA's 5 observed the shelf was barely secured to the wall. The child care center shall be clean , safe , 6 a) 7 sanitary and in good repair at all times to ensure the safety and well-being of ch ildren, employees and visitors. POC due to licensing by Dec 19 2012. Director will 1 inspect all areas of preschool classrooms to 2 determine if there are any other hazards. Shelf was removed immediately during the visit. 3 1 4 5 6 7 1 2 2 3 4 5 6 3 4 5 6 7 7 1 1 2 2 3 4 5 6 7 3 4 5 6 7 1 1 2 3 4 5 6 7 2 3 4 5 6 7 ---- - --- ·- - - - - - - - -- Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: ,e~L~1\~ DATE : 12/18/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 1t,~ DATE: 12/18/2012 This Notice must be posted for 30 days LIC809 (FAS) • (06104) Page : 2 of 2 r' r' All POC Have Been Cleared STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CLEARED DEFICIENCIES CCLD Regional Office, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGEPRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 12/18/2012 POC Due Date I Section Number 1 PLAN OF CORRECTIONS(POCs) Date Cleared I Comments I 12/18/2012 I1 101238 2 POC due to licensing by Dec 19 2012 . Director will inspect all 3 ~I 12/19/2012 4 areas of preschool classrooms to determine if there are any 3 classrooms were inspected other hazards . 5 4 6 Shelf was removed immediately during the visit. 7 Section Cited 1 12 3 4 5 6 1 2 3 4 7 Section Cited 1 12 3 4 5 6 1 2 3 4 7 Section Cited 1 12 3 4 5 6 7 1 2 3 4 ~ r- Lawler, Barbara@DSS From: Sent: To: Subject: Antonia Solorio Wednesday, December 19, 2012 3:06 PM Lawler, Barbara@DSS Plan of corrections type A preschool Plan of correction type A 101239 (a)(2) preschool The children will start taking their shoes inside the room not outside. Type A 101238 preschool I Yasmin did a walk trough the rooms cheking for hazardous shelves or objects in the room. So I can provide a safe environment for the children . Sent from my iPhone On Dec 19, 2012, at 9:49AM, " Lawler, Barbara@DSS" wrote: > > >-----Original Message----> From : 2911K0725501@DSS .CA.GOV [mailto:2911K0725501@DSS .CA.GOV] >Sent : Wednesday, December 19, 2012 10:48 AM >To : Lawler, Barbara@DSS >Subject: Attached image data . > >This is image data from the scanner. > <63563 .pdf> ,-. f' STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: YASMIN SOLORIO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 64 CENSUS: 16 UNANNOUNCED TYPE OF VISIT: POC MET WITH: Yasmin FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 12/07/2012 03:20PM 03:21 PM NARRATIVE LPA Barbara Lawler made today's annual required visit and inspected the infant program, for compliance with Health, Safety and Title 22 regulations . 1 2 3 4 5 LPA inspected the preschool play yard for repairs made to the ground surface , and surrounding areas. Director emailed POC pictures on Nov 1, 2012 and LPA approved the corrections on Nov 5, 2012. 6 7 LPA inspected the repaired black top surfaces today. Ground surfaces observed level and safe for children's 8 play. 9 10 11 NOTICE OF SITE VISIT POSTED 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 I LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2012 ~ I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: I ~ • ~~ DATE: 12/07/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page : 1 of 1 r-- r-- STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: YASMIN SOLORIO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE :CA CENSUS: 11 CAPACITY: 64 UNANNOUNCED TYPE OF VISIT: Case Management Cristy and Yasmin MET WITH: 1 2 3 I FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE : TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 10/23/2012 10:15 AM 02:20PM NARRATIVE LPA Barbara Lawler made today's visit to investigate the October 10, 2012 incident involving two children on the play yard. LPA initially met with Cristy. 4 5 LPA inspected the play yard and ground surfaces . Astroturf has been added to the play yard by the riding 6 path . 7 LPA observed a large crack in the black top, which poses a tripping hazard to the children . Christy states a 8 recent power wash to the surface has exposed the crack and uneven surfaces . 9 10 LPA and Yasmin reviewed the documentation submitted to licensing . LPA also discussed with Yasmin, in her 11 absence , a fully qualified infant teacher must be on site . Because this center is a combination infant and 12 preschool , a designee must be a fully qualified infant teacher. 13 14 This investigation reveals that on October 10, 2012 a teacher was supervising ten children on the play yard , 15 when the teacher turned her back on seven children to assist a child who had fallen . While the teacher's 16 attention was on the crying child, two children engaged in inappropriate child on child contact. 17 18 See following lie 809D for TYPE A violation: 19 NOTICE OF SITE VISIT POSTED Upon receipt, licensee shall post for 30 days and provide copies of this 20 licensing report to parents/guardians of children in care at the facility within the next 24 hours or the next time 21 the child is in care , and to parents/ guardians of children newly enrolled at the facility during the next 12 22 months. Failure to keep the Notice of Site Visit posted for 30 days may result in a $100 Civil Penalty. Failure 23 to complete the plan of correction may result in a civil penalty. 24 Appeal rights provided . 25 TELEPHONE: (707) 588-5026 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE : ~~~w DATE: 10/23/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: "1?~ DATE: 10/23/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page: 1 of 2 r' r' STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE : 10/23/2012 DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number Type A 10/24/2012 Section Cited 101229 (a) (1) Type A 10/23/2012 Section Cited 101238.2 DEFICIENCIES 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Two children engaged in inappropriate physical conduct as a result of a lack of supervision . (a)The licensee shall provide care and supervision as necessary to meet the children's needs . (1) No child(ren) shall be left without the supervision of a teacher at any time , except as specified in Sections 101216.2(e)( 1) and 101230(c)( 1). Supervision shall include visual observation . Black top play yard surface is cracked , and observed with uneven surfaces. (d) The surface of the outdoor activity space shall be maintained : (1 )In a safe condition for the activities planned . (2) Free of hazards including , but not limited to, holes , broken glass and other debris , and dry grasses that pose a fire hazard . PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 When one teacher is alone on play yard , children will not be allowed to go to bark/sand area. When a teacher needs to move to another area of yard to attend to a child's needs all of the ch ildren will be redirected to follow the teacher so that appropriate supervision is provided. Teacher will supervise the children on the rid ing path/astro turf area . All staff have been retra ined on visually supervising the children at all times , by never turning your back on any child . If a ch ild needs to go inside to the bathroom , or teacher needs assistance on the yard , the teacher will call the director or available staff to assist. POC cleared during the visit. 1 2 3 4 5 6 7 Effective immediately, children will not be allowed on the areas designated with cracks , and uneven surfaces. This will be maintained by staff supervision until the repairs are made . I will place cones or adequate coverings (picnic tables etc) over all eneven surfaces before center opens Oct 24th . I will obtain repair bids by Oct 24 and notify licenisng when the repa irs will are to be completed , by Oct 26. I will notify CCL when repairs are to be completed , By Oct 31 and send pictures to CCL of repaired surfaces dates of completion is subject to approval. . 1 1 2 2 3 3 4 4 5 6 5 6 7 7 1 1 2 2 3 4 5 6 7 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: ~~~[,J DATE: 10/23/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. r' ~ FACILITY REPRESENTATIVE SIGNATURE: ~ DATE: 10/23/2012 This Notice must be posted for 30 days LIC809 (FAS) - (06/04) Page: 2 of 2 r r Lawler, Barbara@DSS From: Sent: To: Subject: Yasmin Thursday, October 04, 2012 11:05 AM Lawler, Barbara@DSS Plan Of correction dated 10/02/12 Children' s Cottage Child Care, Inc. I 078 East Ave, Napa Preschool License# 283005477 September 28, 20I2 LP A Barbara Lawler Community Care Licensing 101 Golf Course Dr Ste A-230 Rohnert Park, CA 94928 This plan Of correction Was complete I 0/02/12 Dear Barbara Lawler, lam writing this plan of correction Type A 101483 .3(b) The plan of correction we talked about is that all the teachers are going to make sure this does not happen again of always making sure that the infants stay with the infants and the preschool with their own age. I therally explained and talked to my staff that was present in the wrong decision making at the time and went over the staff ratios. We have one infant teacher for the infant room and one preschool teacher and one teacher at 7:30 for the infants and one at 7:45 for helping for who ever needs it. We also talked in case we needed an extra staff there is someone that is available in the campus to be at an immediate help the person car pools with a teacher and she is here early incase shes needed. I been calling parents and put a paper in the sign in sheet where they can read about correcting their schedule for dropping in and picking up on time, the parents will read that paper and correct the schedule if needed and we will not take any child that comes in earlier than their schedule. Plan of correction Type A I 0 I4I6.2 I already went over this plan of correction with you Barbara we found out that Jessica was fully qualify. And I will make sure that I will have everyone that has taken any classes that I obtain their correct clases so we don't have this happen again. Plan of correction Type b 10 14I6.3 There was a fully qualified teacher supervising an aid at all times during our opening and closing times. Plan of correction type A 101416.5 My plan of correction is I had a staff meeting with the present staff 1 ,......... r-- that was presented in the wrong dec1.,10n time there was an explanation and training on staff ratios and infant ratios for opening and closing times this should not happen again. Infant and preschools stay in their own different clases. The plan of correction we talked about is that all the teachers are going to make sure this does not happen again of always making sure that the infants stay with the infants and the preschool with their own age. I therally explained and talked to my staff that was present in the wrong decision making at the time and went over the staff ratios. We have one infant teacher for the infant room and one preschool teacher and one teacher at 7:30 for the infants and one at 7:45 for helping for who ever needs it. We also talked in case we needed an extra staff there is someone that is available in the campus to be at an immediate help the person car pools with a teacher and she is here early incase shes needed. I been calling parents and put a paper in the sign in sheet where they can read about correcting their schedule for dropping in and picking up on time, the parents will read that paper and correct the schedule if needed and we will not take any child that comes in earlier than their schedule.Adding to that we will be having a staff meeting today Tuesday October 2,2012 at 6:15pm to cover how can we make better decisions and training in regulations. Sent from my iPhone 2 ,--.. ~ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A -230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: YASMIN SOLORIO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CENSUS: 14 64 CAPACITY: UNANNOUNCED TYPE OF VISIT: Case Management Yasm in Solorio-Vallejo MET WITH: 1 2 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 09/28/2012 10:15 AM 03:15PM NARRATIVE LPA Barbara Lawler made today's visit and discussed with director quarterly director' s meeting and staff training . 3 4 5 6 7 LPA received today a copy of the third quarter, minutes of the Board of Directors held on July 10, 2012 and July10 staff training agenda with staff in attendance. 8 9 LPA and Yasmin discussed the amended licensing reports of the May 18th and May 21 , 2012 facility visits , 10 and 11 copies of these reports were provided . 12 13 14 J LPA reviewed criminal background clearances for all staff. 15 16 17 18 1 NOTICE OF SITE VISIT POSTED FOR 30 DAYS 19 20 21 22 23 24 25 TELEPHONE: (707) 588-5026 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: 707-588-5058 LICENSING EVALUATOR SIGNATURE: DATE : 09/28/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: rf<.AM ~ DATE: 09/28/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page: 1 of 1 .~l~o) STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY r' -../ ~/J el..uF~lr~LSERVICES ~cj, Q-'~LIJ CIVIL PENALTY ASSESSMENT- IMMEDIATE FACILITY NAM E DATE Children's Cottage 04/06/2012 FACILITY AD DRESS CITY 1078 East Ave STAT E ZIP CODE Ca Napa OPERATOR(S) 94559 FACILITY# IF LICENSED OR PENDING: Children's Cottage Child Care Inc. 283005477 Immediate civil penalties can be assessed against any licensee for failure to comply with Caregiver Background Check requirements and against family child care licensees for failure to comply with parent/authorized representative (AR) notification and visit report posting requirements. See the back of this form for specifics. On this date you have been found in violation of one or more requirements for which an immediate civil penalty is warranted . See the Licensing Report (LIC 809 or LIC 9099) issued on this date. You are hereby notified that a civil penalty has been assessed . Caregiver Background Check $100 immediate Civil Penalty per person for allowing any person (who is subject to a background check) to work, reside or volunteer without a criminal record clearance or exemption . Maximum of 5 days for the first violation . Maximum 30 days for subsequent violations. 0 0 $100 immediate Civil Penalty per person for allowing any person (who is subject to a Caregiver Background Check Order of Removal) to work, reside or volunteer. GZJ $100 immediate Civil Penalty per person for allowing a cleared or exempted person to work, reside or volunteer before requesting a clearance transfer or before receiving approval of an exemption transfer. number of days x $100 = $ 100.00 Penalty Individual #2 A ~.<~n"' .Jl.z.,~~number of days x $100 = $ 100.00 Penalty lndividuaJ.-.#..:1· Individual #3 ' Unumber of days x $100 = $_ _ __ Penalty Child Care Facilities Only 0 $100 immediate Civil Penalty per parent/AR for failure to provide "Family Child Care Home (FCCH ) Addendum to Notification of Parents' Rights (Regarding Exclusion)".# parent/AR x $100 = $ penalty 0 $100 immediate Civil Penalty per parent/AR for failure to provide "Family Child Care Home Addendum to Notification of Parents' Rights (Regarding Reinstatement)" . # parent/AR x $100 = $ penalty 0 $100 immediate Civil Penalty per parent/AR for failure to obtain signature indicating receipt of Addendum. # parent/AR x $100 = $ penalty 0 $100 immediate Civil Penalty for failure to provide signed addendum to the Department when requested . 0 $100 immediate Civil Penalty for failure to comply with posting requirements for 30 consecutive days. 0 $50 immediate Civil Penalty for failure to return "Confirmation of Removal" form to Licensing within 5 days. (FCCH only) » /QJ Total PenaltyAssessed $_2_Q_Q._ Q_ G_ __ YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. NAME OF LICENSI NG PROGRAM ANALYST SIGNATURE OF LICENSING PROGR AM ANALYST Aj~;?j Barbara Lawler NAME OF FACILITY REPRESENTATIVE/TITLE DATE 04/06/2012 DATE Yasmin Solaria-Vallejo TITLE LIC421B (7/1 1) U~1 D 7/ t71 {'IPAGE 1 OF 2 _.I STATE OF CAUFORNIA - HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT r' CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, 101 GOLF COURSE DR STE. A-230 ROHNERT PARK, CA 94926 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL FACILITY NUMBER: ADMINISTRATOR: YASMIN SOLORIO-VALLEJO FACILITY TYPE: ADDRESS: 1078 EAST AVENUE TELEPHONE: CITY: NAPA STATE: CA ZIP CODE: CAPACITY: CENSUS: 16 DATE: 64 TYPE OF VISIT: UNANNOUNCED TIME BEGAN: Annual/Required Yasmin Solorio-Vallejo MET WITH: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 05/21/2012 11 :45 AM 02:15PM NARRATIVE 1 The following is an amended report. 2 LPA Barbara Lawler made today's follow-up visit and inspected for health, safety and Title 22 compliance. 3 LPA Lawler discussed the following with Yasmin : 4 Adequate and appropriate visual supervision of children Section 101229 states: No child shall be left without 5 the supervision of a teacher at any time, supervision shall include visual observation (except in Sections 6 101216.2(e)(1) and 101230 (c)(1). During today's visit LPA entered primary preschool classroom while 7 observing twelve children eating lunch at two tables . No staff was observed. Briefly later, a teacher was 8 observed coming out of the storage room with mats. The teacher could not see the children at their lunch 9 tables, from the storage room . The teacher's view of children was obstructed by the lay out of the classroom. 10 Designation of Facility Responsibility on file lists one staff currently working . 11 The fully qualified teacher (designated with facility responsibility) was going to leave early on May 18, 2012 12 without a backup. Fully qualified staff with designation of facility responsibility shall have working knowledge 13 of the operation of center and knowledge of facility files. 14 Lie 9182 Criminal Background Clearance Transfer Request, if an individual is not currently associated to a 15 facility complete the lie 9182 with Licensing Information System ID and complete the last section, TO THE 16 FOLLOWING FACILITY. If in doubt of how to complete any form, contact licensing and speak with your LPA 17 or Desk Duty LPA for child care. 18 LPA discussed with Yasmin how they ensure sand box is free of debris and animal urine and droppings. 19 Sand box does not have a cover. Yasmin states the owner researched sand box safety. Vinegar is applied 20 weekly to the entire sand box, every Friday. Each morning staff inspect the sand boxes prior to children going 21 outside, to ensure the sand box is clean and free of any debris. 22 23 See following lie 809D: 24 NOTICE OF SITE VISIT POSTED THIRTY DAYS 25 TELEPHONE: (707) 588-5055 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATI DATE: 05/21/2012 eport must be available at Child Care and Group Home facilities for public review for 3 years. Page: 1 of 2 r i STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, 101 GOLF COURSE DR STE. A-230 ROHNERT PARK, CA 94928 FACILITY EVALUATION REPORT (Cont) FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A Type A 05/21/2012 Section Cited 101229 FACILITY NUMBER: 283005477 VISIT DATE: 05/21/2012 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Usually at least two teachers are supervising the Twelve preschool age children were in classroom children. I will send POC to licensing by May 24th without the visual observation of the teacher. The teacher was in the storage room gathering mats for nap time. The teacher could not see the children while setting up the mats. (a) The licensee shall provide care and supervision as necessary to meet the children's 1 1 needs. 2 2 (1) No child(ren) shall be left without 3 3 the supervision of a teacher at any time, except as 4 4 specified in Sections 101216.2(e)(1) and 5 5 101230(c)(1). Supervision shall include visual 6 6 7 7 observation.(a) The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without (1) the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. 1 2 1 2 4 5 6 7 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 3 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2012 ,...-. r- STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:YASMIN SOLORIO-VALLEJO ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CENSUS: 16 64 CAPACITY: UNANNOUNCED POC TYPE OF VISIT: Yasmin Solorio-Vallejo MET WITH: 1 2 3 4 5 6 7 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 05/21/2012 11:45 AM 02 :35PM NARRATIVE LPA Barbara Lawler made today's visit and inspected plan of corrections . LPA verifed disposable cups are readily available by children's sink , for drinking water. Rusty substance was removed from cabinet under children's hand washing sink, no odor observed. By May 24th director will mail written POC's for Sign in and Out sheets and how staff will provide appropriate supervision on play yard and in classroom (when one teacher is in ratio with children and setting up napping mats). 8 9 During today's visit director faxed updated lie 9182 to have criminal background clearances transferred to 10 preschool license, for staff, cited May 18 2012. This teacher is allowed to supervise children , May 21st. 11 12 13 Notice Of Site VIsit Posted 14 15 See following lie 809D 16 17 Parents are to receive copies of all Type A licensing reports next day child is in care , and newly enrolled 18 parents for the next twelve months. Lie 9224 shall be signed by each parent and maintained in children's 19 files . 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: ~~>NJ~ DATE: 05/21/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) Page : 1 of 1 r' All POC Have Been Cleared STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CLEARED DEFICIENCIES CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGEPRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 05/21/2012 POC Due Date I Section Number 05/21/2012 101238 05/21/20 12 Section Cited 101229 PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 Date Cleared I Comments Until we can order and install additional chipped bark, staff will rake bark from perimeter of yard , and from under areas not needing cushioning and distribute bark under all fall zones. ~ 05/23/2012 Bark will be raked daily or as needed before children use play 3 CCL rece ived written POC by email ard . Bark will be raked effective May 21 , 2012 . I will contact 4 he owner for ordering additional bark and notify licensing hen bark is to be installed. No later than June 30th . I 1 2 ; !Usually at least two teachers are supervising the ch ildren . I 5 1will send POC to licensing by May 24th 6 2 05/23/2012 rece ived written POC by emai lccl 3 4 7 1 Section Cited 2 3 4 5 6 7 1 2 3 4 1 Section Cited 2 3 4 5 6 7 1 2 3 4 r- I LICENSING EVALUATOR SIGNATURE: J¢MJJ~~ DATE: 05/21/2012 ~ I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~ ~ DATE: 05/21 /20 12 This Notice must be posted for 30 days LIC809·0 (FAS) • (06/04) Page : 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CONTACT SHEET CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This form is intended to document contacts concerning the facility identified below. Such contacts may include notification of corrections by the facility. Limit the information to public information . File on the top right side of the faci lity folder. Enter tic (telephone call) or o/v (other visit) in the first column . Enter the contact date in the second column . Under Summary of Contacts enter relevant information including action taken and follow up. Enter initial and last name after each entry. FACILITY NUMBER FACILITY NAME CHILDREN'S COTIAGE- PRESCHOOL Contact Type Date tic 05/23/2012 283005477 Summary of Contacts 1 Director states bark will be delivered June 10 2012 2 POC's emailed May 22 2012 3 06/06/2012 1 Rece ived pictures of newly added bark POC cleared 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 LIC185 (FAS) • (5/99) · (PUBLIC) Pag e. 1 of 1 STATE OF CALIFORNIA- HEAllli AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, 101 GOLF COURSE DR STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL FACILITY NUMBER: ADMINISTRATOR: YASMIN SOLORIO-VALLEJO FACILITY TYPE: ADDRESS: 1078 EAST AVENUE TELEPHONE: CITY: NAPA STATE: CA ZIP CODE: CAPACITY: 64 CENSUS: 18 DATE: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: Annual/Required MET WITH: Lisa Crane TIME COMPLETED: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 283005477 850 (707) 224-3825 94559 05/18/2012 02:15PM 04:40PM NARRATIVE This is an amended licensing report. LPA Barbara Lawler made today's visit and inspected for compliance with health, safety and Title 22 regulations. Facility file was reviewed prior to visit. Fully qualified teacher, Lisa Crane was in charge of the facility. LPA and Lisa reviewed criminal background clearances for staff present today. Five staff were caring for 18 preschool age children in the large classroom. Site has working telephone, ventilation and lighting are adequate throughout the classroom and bathroom. Classroom water fountain does not deliver drinking water. Rust substance and mildew odor was observed under children's hand washing sink. Four toilets and three hand washing sinks are available to the children , stocked with toilet paper, hand soap and paper towel. Ratios and capacity observed in compliance. Fire and disaster drills are conducted and documented at least twice a year. Floor surfaces are clean and safe. A variety of age and developmentally appropriate toys, furnishings and activities are available. At least one teacher has current EMSA pediatric CPR and First Aid. Play yard is fully fenced. Shade and drinking water are provided. Climbing structures are cushioned by chipped bark, observed adequate depth. Toys are safe and in good repair. See following lie 8090. LPA discussed TYPE A deficiencies are to be posted with Notice of Site Visit for 30days and parents shall receive copies of all TYPE A licensing reports and sign lie 9224 for a period of twelve months. Civil penalty assessed today. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2012 This r port must be available at Child Care and Group Home facilities for public review for 3 years. Page: 1 of3 STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY EVALUATION REPORT (Cont) FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 05/18/2012 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A Type A 05/18/2012 Section Cited 101238 a Type A 05/21/2012 Section Cited 101238 a Type A 05/21/2012 Section Cited 101238 a DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 1 2 3 4 5 6 6 7 7 1 2 3 4 5 Tall bookcase in Circle Time room is not secured or anchored to the wall. (a) The child care center shall be clean , safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees 6 and visitors. 7 1 CHildren will not be allowed in this room until the 2 book case in anchored to the wall and proof of 3 correction is sent to licensing. 4 5 Cabinet under hand washing sink smells of mildew and rust substance was observed of lower surface of cabinet. This area is readily accessible to The children and cabinets are not latched . (a) child care center shall be clean, safe, sanitary and 6 in good repair at all times to ensure the safety and well-being of children, employees and visitors. 7 1 2 3 4 5 1 2 3 4 5 1 POC will be mailed to licensing on May 21 2012. 2 3 4 5 1 2 3 4 5 Drinking water fountain is in disrepair and does not deliver adequate water. Chiild was observed drinking from fountain, and child's mouth was touching the water fountain fixture . Teacher states children use disposable cups for collecgting 6 drinking water from hand washing sink. LPA 7 observed no water cups at the sinks. 6 7 Monday May 21 2012 I will contact plumber or approved repair person to schedule maintainence by May 23 2012 for appropriate repairs. I will check the surface and area reguarly to ensure the area is clean and healthy. 6 7 6 7 Failure to correct the cited deficiency(ies}, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR 51 DATE: 05/18/2012 form and understand my appeal rights as explained and received. FACI TY REPRESENTATIVE SIGNATURE: DATE: 05/18/2012 This Notice must be pos ed for 30 days LIC809 (FAS) - (06/04) Page: 3 of 3 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 05/18/2012 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 Type B 05/22/2012 Section Cited 101229.1 1 2 3 4 5 6 7 Type B 05/18/2012 Section Cited 101229 POC to be sent to licensing May 18, 2012. 13 children were under the supervision of two teachers, one teacher walked over to sand box and 1 1 seond teacher was across the yard and had her 2 2 back to 9 children , while applying sunscreen to a 3 child and facing 3-4 children at the water founta in. 3 4 4 5 5 No child(ren) shall be left without (1) 6 the supervision of a teacher at any time, except as 6 7 7 specified in Sections 101216.2(e)(1 ) and 101230(c)(1). Supervision shall include visual observation. Sign in and out sheets were reviewed and found incomplete. CHildren's sign in and out sheets were missing dates of attendance, missing signatures fo droff off and pickup, times of drop off or pick up missing , and incomplete signatures. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 I will send written notification to each parent with licensing requirements by May 22 2012. Director or designee will review all sign in and out sheets for completeness each day, and at pickup time review with parenUparents as needed. I will mail licensing a copy of my written communicaiton with parent by May 22, 2012 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker · TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATO DATE: 05/18/2012 th1S form and understand my appeal rights as explained and received. TY REPRESENTATIVE SIGNATURE: DATE: 05118/2012 LIC809 (FAS) - (06104) Page: 2 of 3 1,;, '- 1,( S'l'A~ 0 • • OA .IFOR ' lA- ~ HEvA!! H ANO _f,!P~AN SERvftt;s - t:' FiACILITY~EVALUATIG>N -~~ - j f'GENC~ .· : \· • REPORT' # - • 6r before the STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR:WELCH , RAY 1078 EAST AVENUE ADDRESS: CITY: NAPA STATE:CA CAPACITY: 64 CENSUS: UNANNOUNCED TYPE OF VISIT: Case Management- Deficiencies MET WITH: Jasmin 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 04/06/2012 03:41 PM 05:00PM NARRATIVE LPA Barbara Lawler was at this facility today on other matters . During the visit LPA discovered that a teacher working in the preschool classrooms does not have criminal background clearances associated to the facility . Although this teacher was a former employee at Children's Cottage , she states she left employment in February 2011 with the intent of relocating out of the area. The clearances were disassociated from Children's Cottage February 2011 . Civil penalty assessed. See following lie 809D for TYPE A Parents Acknowledgement of Receipt of TYPE A Licensing Reports and posting of TYPE A licensing Reports and Notice of Site Visit to be posted for 30 days were discussed. I SUPERVISOR'S NAME: Linda Walker !! TELEPHONE : (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE : 04/06/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 't{,~~ DATE: 04/06/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809-0 (FAS )- (06/04) Page : 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 04/06/2012 Section Cited 101170 FACILITY NUMBER: 283005477 VISIT DATE: 04/06/2012 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 Teacher supervising children does not have 2 fingerprint clearances associated to the facility. 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 1 2 3 4 5 6 7 2 3 4 5 6 7 I will contact licensing and verify staffs clearance information, complete a lie 9182 and fax to licensing before allowing the teacher to return to work. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler u TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~"v~ DATE: 04/06/2012 This Notice must be posted for 30 days LIC809 (FAS) - (06/04) Page : 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Reg ional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:WELCH , RAY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA 64 CAPACITY: CENSUS: 18 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Yasmin Solaria 1 2 3 4 5 6 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/29/2011 10:30 AM 10:45 AM NARRATIVE LPA conducted an unannounced facility visit for the purpose of case management. Present are children with staff. Ratio is met. It has been determined that not all parents of children in care at the facility or parents of newly enrolling children have received copies of documents required of AB633 . Type A citations and an Accusation were not given out to all parents. This is discussed with Yasmin as is a letter she gives to parents to explain a Type A deficiency. Health and Safety Code1596.817 is also given today. See 8090 for deficiency. Appeal Rights are given. Notice of Site Visit is posted. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2011 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) Page: 1 of 2 J STATE OF CALIFORNIA· HEALTH AND HU MAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CH ILDREN'S COTIAGE - PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number Type B 09/05/2011 Section Cited HS 1596.8595c Type B 08/30/2011 Section Cited 1596.8595(a)(1) FACILITY NUMBER: 283005477 VISIT DATE: 08/29/2011 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 A lice nsed chi ld care home shall provide to the parents of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health , safety, or personal rights of children in care as specified in paragraph (1) of subdivision (a) of Section 8 9 10 11 12 13 14 1596.893b. It has been determined that not all 8 parents have received copies of Type A citations or 9 of an Accusation served 3/1/11. This was cited 10 1/3/11 . A civil penalty applies. 11 12 13 14 1 2 3 4 5 6 7 License . During the hours when clients are present the licensee shall post its license in a prominent, publicly accessible location in the facility . Today, the Notice of Site Visi t is posted on a bulletin board placed on the floor and leaning against the wa ll behi nd a table and chairs in the office/lobby area. Type A violation given 8/23/11 is not posted . 8 The notices are required to be posted on or 9 immediately adjacent to the interior side of th e 10 main door to the facility. 11 12 13 14 1 2 3 4 I will ensure that all parents receive a copy of information required and get a signed receipt, LIC 9224 . I will send a copy of LIC9224 to CCL for the 6 parent names on the list given today. 5 6 7 1 2 3 4 5 6 7 I will read 1596.817 which I was given today. I will ensure that all requ ired postings are posted in accordance with reg ulation to ensure that parents see the postings . 8 9 10 11 12 13 14 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: ~vf(p~~ DATE: 08/29/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE : DATE: 08/29/2011 LIC809 (FAS) • (06/04) Page: 2 of 2 CAliFORNIA OEI'II\RTMENT OF SOCIAL SERVICES STATE OF CALFORNIA • HEALTH AND HUMAN SERVICES AGENC. ~ FACILITY VISIT SUMMARY REPORT Complaint Control Number: FN::IUTY TYPE MET WITH: TYPE OF VISIT C::: Complaint C ~ Prelicensing Management 0 0 0 Random POC Required 0 {J :)D Announced TNE~TED 'E( Unannounced DEFICIENCY/CIVIL PENALTY INFORMATION Type A 0 0 Type B 0 0 No Deficiency Cited 0 ;&I /."3D Civil Penalty Assessed Penalty Notice Given Penalty Cleared 0 0 0 Penalty Not Cleared Deficiencies Cleared Deficiencies Not Cleared Program/Operation Health Related/Medical Services Physical Plant Qualifications 0 0 0 0 Staffing/Ratio Care and Supervision Personal Rights Other AREA OF DEFICIENCY(IES) 0 C 0 0 0 0 0 0 Limits of License Criminal Record Records Food Service Deficiency Description II I ave read and understand the electronic version of the full licensing report completed today at this facility. I acknowledge receipt of this form and understand my appeal rights as explained on the back of this form. If "A" violations are cited, child care providers must post this reP.ort pending receipt of final report. FOR LPA USE WHEN PROVIDING A PRINTED COPY OF THE ELECTRONIC REPORT TO THE UCENSEE: I certify that the attached is a true and correct copy of the electronic field visit report completed at the facility on ________________~~---------------(Date) (LPA Signature) LIC 809S (8104) (Date) PAGE 1 OF 2 I I ..__./ -......./ STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visiUinvestigation of a complaint received in our office on 06/20/2011 and conducted by Evaluator Susan Keehn PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20110620160452 FACILITY NAME: CHILDREN 'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH, RAY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 14 UNANNOUNCED MET WITH: Yasmin Solario FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/29/2011 10:30 AM 11 :30 AM ALLEGATION(S): 1 Neglect/Lack of Supervision 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA S. Keehn visited for the purpose of delivering findings of the above allegation . Investigation consisted of 2 interviews with staff, parents, and children. The specific allegation was that children have been involved in a 3 game in which two or more children pull their pants down . Children were not reported to touch each other. 4 Director Yasmin denies that parents have come to her about this . Investigation findings reveal that on one or 5 more occasions within the last few months, children have either been involved in a game of pull ing down their 6 pants or have observed other children pull down their pants with no intervention or knowledge of staff. This 7 allegation is substantiated . 8 See 809D for deficiency. Appeal Rights given . Notice of site visit posted . Failure to keep this notice 9 posted for 30 days may result in a civil penalty of $100 . Upon receipt, licensee shall post and provide copies 10 of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of 11 ch ildren newly enrolled at the facility during the next 12 months. Failure to complete plan of correction may 12 result in a civil penalty. 13 Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: 4 DATE: 08/29/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of 3 Control Number 01 -CC-2011 0620160452 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVI SION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regiona l Office , 101 GOLF COURSE DR. STE. A-230 ROH NERT PARK, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE: 08/29/2011 FACILITY NAME: CH ILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 08/30/2011 Section Cited 101229(a)(1) DEFICIENCIES 1 2 3 4 5 6 PLAN OF CORRECTIONS(POCs) No Child(ren) shall be left without the supervision , including visual observation , of a teacher at any time. Investigation find ings reveal that children in care were involved in a game of pulling down pants without the knowledge or visual observation of a teacher. No touching is reported to have occurred. 7 This is an 1 I will send a written written plan of correction 2 regarding what will be done differently regarding 3 4 5 6 8 immediate risk to children. This is a second 9 violation within 12 months and a civil penalty 10 applies. 11 12 13 14 8 9 10 11 12 13 14 1 2 3 4 5 6 1 2 3 4 5 6 7 7 1 2 3 4 5 6 1 2 3 4 5 6 7 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Li nda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2011 This Notice must be posted for 30 days LIC9099 (FAS ) • (0 6/04) Page: 3 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/20/2011 and conducted by Evaluator Susan Keehn PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-2011 0620160452 FACILITY NAME: CHILDREN 'S COTTAGE - PRESCHOOL ADMINISTRATOR:WELCH , RAY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CENSUS: 14 CAPACITY: 64 UNANNOUNCED MET WITH: Yasmin Solaria FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE : DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/29/2011 10:30 AM 11 :30 AM ALLEGATION(S): 1 Personal Rights 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA S. Keehn visited for the purpose of delivering findings of the above allegations. Investigation consisted 2 of interviews with staff, parents and children . The allegation is related to a game that some children have been 3 involved in a of pulling down pants or that children have observed other children pull down their own pants. 4 Children were not forced to play the game nor is there indication that children were upset by this; therefore it 5 can not be determined if this violated the personal rights of the children involved . Although children have the 6 right to a safe environment and adequate supervision , there is no evidence that children were physically or 7 emotionally harmed . The allegation is inconclusive. 8 9 Notice of Site Visit is posted . 10 11 12 13 Estimated Days of Completion: Inconclusive SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 05/13/2011 and conducted by Evaluator Susan Keehn PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20110513154100 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 18 UNANNOUNCED MET WITH: Yasmin Solaria FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/29/2011 10:30 AM 11 :30 AM ALLEGATION(S): 1 PHYSICAL PLANT: Facility is dirty 2 PHYSICAL PLANT: Facility smells 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA S. Keehn visited for the purpose of delivering findings of the above allegations. Investigation 2 consisted of interviews with complainant, staff, and parents. Staff deny the allegations and state that other 3 than an occasional stinky diaper, there is no odor. The above allegations are found to be inconclusive as other 4 parents have not had issue with the cleanliness of the facility. On 5/23 , 6/20 , 8/23 and today the facility is 5 observed to be clean with no foul odor. 6 7 8 9 10 11 12 13 Inconclusive Estimated Days of Completion: SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: J~ DATE: 08/29/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , RAY ADDRESS: 1078 EAST AVENUE STATE:CA CITY: NAPA CENSUS: 24 CAPACITY: 64 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Yasmin Solaria 1 2 3 4 5 6 7 8 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 08/23/2011 11:30 AM 02:30PM NARRATIVE LPA S. Keehn conducted an unannounced facility visit for the purpose of case management. Present are 24 children with 3 staff. Due to laptop problems, a handwritten report was left and this report is sent the following day. See 809D for deficiency . Appeal Rights given. Notice of site visit posted will be posted by the director. Failure to keep this notice posted for 30 days may result in a civil penalty of $100 . Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Failure to complete plan of correction may result in a civil penalty. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Wal ker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2011 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) Page: 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALI FORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 08/23/2011 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 08/24/2011 Section Cited 101216.3(a) DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 1 A written plan of correction will be subm itted by Teacher- Child Ratio. There shall be a ratio of one teacher supervising no more than 12 children 2 8/24/11 . in attendance except as specified in (b) and (c). A 3 ratio of 1 fully qualified teacher 1 aide for every 18 4 5 children in attendance in a preschool program is 6 allowed when the aide meets the qualifications in 7 Section 101216.2(d) 8 9 10 11 12 13 14 Today there is a teacher who is not fully qualified, with an aide who does not meet the requirements supervising 18 children. 2 children are in coat room and one is in the bathroom with staff at both doors. This is immediate risk as neither staff qualifed and not all children could be visually supervised . 8 9 10 11 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Co rrection (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: J DATE: 08/24/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2011 This Notice must be posted for 30 days LIC809 (FAS) - (06/04) Page : 2 of 2 ) I '-.-/ STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY -..._.) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES CIVIL PENALTY ASSESSMENT FACILITY NAME DATE Children's Cottage 08/29/2011 FACILITY ADDRESS 1078 East ave. CITY STATE ZIP CODE Napa, CA 94559 LICENSEE(S)IOPERATOR FACILITY' Ray Welch 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.58. You are hereby notified that a civil penalty has been assessed. The above facility has been found in .violation of the California Code of Regulations, Title 22 , Divisions 6, and/or 12, Section(s) __j__Qj2_~ow1~~--------------------------------­ and/or California Health and Safety Code, Division 2, Chapters 3, 3.01 , 3.2 , 3.4, and 3.5, and 3.6. Section(s) HS1596.8595c -150 .00 A Licensing Report (LIC 809 or LIC 9099) was issued on _ _ _ _ __,_ O_u 1!-"'03,-'/..,. 20.,__1._.1_ _ __ correct the above violation(s) would result in a civil penalty. DATE giving notice that failure to Because you failed to make the corrections specified on the LIC 809 , a civil penalty of$ ______ is assessed for the period from through _ _ _ _ _ __ DATE DATE A civil penalty of $50 per violation per day, up to a maximum of $150 per violation per day will be assessed. This will continue until correction(s) is made to comply with the licensing laws, regulations, and approval of the California Department of Social Services or authorized licensing agency. V Because you repeated a violation of the same subsection within a 12-month period, an immediate civil penalty of 150.00 is assessed for the period from 08/29/2011 through 08/29/2011 $ DATE DATE All Facility Types Except Child Care Centers: Second citation within a 12 month period; an immediate civil penalty of $150 per violation ; then $50 per day per violation until corrections are made. I , Child Care Centers Only: Second citation within a 12-month period; an immediate civil penalty of $150 per violation; then $150 per day per violation until corrections are made. ' Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically Ill (RCF-CI): Third citation within a 12-month period; an immediate civil penalty of $1 ,000 per violation ; then $1 00 per day per violation until corrections are made. Family Child Care Home (FCCH), Child Care Center (CCC) , Community Care Facility (CCF): Third citation within 12month period ; an immediate civil penalty of $150 per violation ; then $150 per day per violation until corrections are made. FCCH and CCC only: Second or subsequent violation for failure to allow parent or guardian to enter and inspect facility or for retaliation/discrimination stemming from a request to enter or lodge a complaint. A civil penalty of $50 per violation_ Total Penalty Assessed $_ 30 _0_._0_ 0 _ _ _ _ __ YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE NAM E OF LICENS ING PROG RAM ANALYST Susan Keehn S IGNA: g O~ RAM ANALYST SUPERVISOR REVIEW/S IGNATUR E (FOR INTERNAL USE ONLY) NAME OF FACILITY REPR ESENTATIVEffiTLE Yasmin Solario g;;;:;::· ~~~ DATE 08/29/2011 LJC421 (7'11 ) PAGE 1 OF 2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 64 CENSUS: UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Yasmin Solaria-Vallejo FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 {707) 224-3825 94559 05/23/2011 10:30 AM 01 :00PM NARRATIVE 1 LPA S. Keehn visited for the purpose of checking on plans of correction for violations issued 4/21 / 11 . 2 Present are children with staff. initially, on arrival, LPA found one staff with 17 children in the large classroom . 3 Children have drinking water readily available by paper cups that they can use at the sink. Yasmin sent a 4 statement stating that staff were training on how to fold bedding to meet the regulation . 5 See 8090 for deficiency. Appeal Rights given. Notice of site visit posted. Failure to keep this notice 6 posted for 30 days may result in a civil penalty of $100. Upon receipt, licensee shall post and provide copies 7 of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Failure to complete plan of correction may 8 9 result in a civil penalty. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 TELEPHONE: {707) 588-5034 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: {707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2011 1acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~ DATE: 05/23/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS)- (06/04) Page: 1 of 2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPART MENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 64 CENSUS: UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Yasmin Solario-Vallejo FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 05/23/2011 10:30 AM 01 :00PM NARRATIVE 1 LPA S. Keehn visited for the purpose of checking on plans of correction for violations issued 4/21 /11 . 2 Present are children with staff. initially, on arrival, LPA found one staff with 17 children in the large classroom . 3 Children have drinking water readily available by paper cups that they can use at the sink. Yasmin sent a 4 statement stating that staff were training on how to fold bedding to meet the regulation . 5 See 809D for deficiency. Appeal Rights given. Notice of site visit posted. Failure to keep this notice 6 posted for 30 days may result in a civil penalty of $100. Upon receipt, licensee shall post and provide copies 7 of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of 8 children newly enrolled at the facility during the next 12 months. Failure to complete plan of correction may 9 result in a civil penalty. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 TELEPHONE: (707) 588-5034 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2011 1 acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~ DATE: 05/23/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06/04) Page: 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type 8 05/31/2011 Section Cited 101229.1 (a) FACILITY NUMBER: 283005477 VISIT DATE: 05/23/2011 DEFICIENCIES 1 Sign in and Sign Out A review of the sign in 2 sheets today for both components show that many 3 children over the course of 2 days are not signed 4 out and a couple are not signed in who are signed 5 out. 6 PLAN OF CORRECTIONS(POCs) 1 I will notify parents and send a copy of notification 2 to CCL by 5/31 /11 . 3 4 5 6 7 7 1 2 3 1 2 3 4 4 5 6 5 6 7 7 1 2 3 1 2 3 4 4 5 6 5 6 7 7 1 2 3 1 2 3 4 4 5 6 5 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Lind a Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: x!J1 DATE: 05/23/2011 ~-...... ----- I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2011 LIC809 (FAS) • (06/04) Page : 3 of 3 .......- J STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT FACILITY NAME CCLD Regional Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 DATE CHILDREN'S COTTAGE CHILD CARE , INC. -INFANT FACILITY ADDRESS 05/23/2011 CITY 1078 EAST AVENUE STATE NAPA ZIP CODE CA 94559 LICENSEE(S)IOPERATOR FACILITY NUMBER CHILDREN'S COTIAGE CHILD CARE , INC. 283007874 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods , per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed . The above facility has been found in violation of the California Code of Regulations , Title 22 , Divisions 6, and/or 12, Section(s) 101229 .1(a) and/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4, and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 04/21/2011 giving notice that failure to correct the above violation(s) would result in a civil pena lty. 0 x x 0 x Because you failed to make the corrections specified on the LIC 809, a civil penalty of $0.00 is assessed for the period from through . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed. This will continue until correction(s) are made to comply with the licensing laws , regulations , and approval of the California Department of Social Services or authorized licensing agency. Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for 05/23/2011 , the day the deficiency was cited . 0 x All Facility Types: Second citation within a 12 month period ; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made . 0 x 0 x Family Residential Care Facility for the Elderly (RCFE}, Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period ; an immediate civil penalty of $1 ,000 per violation then $100 per day per violation until corrections are made. Child Care Homes (FCCH}, Child Care Centers (CCC), Community Care Facility (CCF) : Third citation within 12 month period ; an immediate civi l penalty of $150 per violation then $150 per day per violation until corrections are made. Violations which result in injury, sickness , or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENS ING PROGRAM ANALYST Susan Keehn SIGNATURE OF LI CENSING PROGRAM ANALYST Yasm in Solaria-Vallejo SUPERVISOR REVIEW SIG NATURE (FOR INTERNAL USE ON LY) DATE 05/23/2011 TITLE LIC421 (FAS) • (05106) Lie Page: 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-2 30 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE - PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 64 CENSUS: 30 UNANNOUNCED TYPE OF VISIT: Annual/Required MET WITH: Yasmin Solario, director 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 04/21 /2011 08 :30AM 05:00PM NARRATIVE LPA's S. Keehn and B. Lawler visited for the purpose of inspecting for compliance with Title 22 Regulations for th is Required Visit. Facility files were reviewed prior today's visit. Ratio and capacity is met. All staff present today have required criminal record clearances . There are no bodies of water observed. It is reported that there are no weapons or poisons on the premises. Site has working telephone. Furniture and equipment is in good condition . The bathrooms appear clean and have sufficient soap, paper towels, and toilet paper to meet the needs of the children . Water temperature at sinks used by children is below 120 degrees. Floors and surfaces appear clean . Food storage area appears clean . Sign in/out sheets were reviewed . Snack menu is posted . Breakfast and lunch are provided by parents. Staff who open and close have current First Aid , CPR and Preventative Health on file . Lighting and ventilation are adequate throughout classrooms and bathrooms. Appropriate and adequate supervision of children was observed . The outdoor play area is inspected , yard is fully fenced and no hazards are observed. Shade is provided . Climbing structure is securely anchored and has sufficient cushioning material beneath and around fall zones. Staff files are reviewed . Ch ildren's files are reviewed . The roster is current and a copy provided today . Lie 311 Records to Be Maintained , Shaken Baby and SIDS brochures are given . See 8090 for deficiency. Appeal Rights given . Notice of site visit posted. Failure to keep this notice posted for 30 days may result in a civil penalty of $100 . Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Failure to complete plan of correction may result in a civil penalty. Licensing information and updates are available at www.ccld .ca.gov. LPA B Lawler authored this report on LPA S Keehn's computer. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: DATE: 04/21 /2011 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21 /2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) Page: 1 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AG ENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LIC ENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type 8 05/04/2011 Section Cited 101221 (a) FACILITY NUMBER: 283005477 VISIT DATE : 04/21/2011 DEFICIENCIES 1 2 3 4 5 PLAN OF CORRECTIONS(POCs) A separate complete and current record for each child is maintained in the child care center. Following children's files were missing forms: child 2,3, and 6 (refer to lie 811) 1 I will send copy of my POC to CCL by 5/4/2011 2 3 4 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE : (707) 588-5034 LICENSING EVALUATOR NAME: Susan Keeh n TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE : &AiJMIS diJA,(&! ~ J1< DATE: 04/21 /2011 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: ~ LIC 809 (FAS ) • (06/041 DATE: 04/21 /2011 Page : 2 of 3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AG ENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILD R EN'S C O TIAG E- PRESC HOOL FACILITY NUMBER: DEFICIENCY INFORMATION FOR THIS PAGE : Defi ciency Type POC Due Date I Section Number Type B 04/21/2011 Sect ion Cited 101238 g Type B 04/21 /2011 Secti on Cited 101239.2 (a) Type B 05/04/2011 Section Cited 101239.1 (c)(2) Type B 05/04/2011 Section Cited 101239 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 Disinfectant spray was on a ledge , in area of 2 children ' s hand washing area of auditorium 3 classroom 4 5 1 2 3 4 5 6 6 POC cleared 7 7 1 2 3 4 5 Drinking water from fixture or container shall be readily available both indoors and outdoors. Drinking fountain in auditorium classroom is not working and does not deliver water 283005477 04/21/2011 VISIT DATE: Removed during visit I will remind staff to store all toxins out of children's reach and verbally by end of business April 22 20 11 1 Until water fountain is repaired children will be 2 provided drinking water in classroom by pitcher and 3 cups . 4 5 6 6 7 7 1 2 3 4 5 Nappi ng mats observed stored touching other children's mats. Mats stored with floor side touching side where child lays Bedding shall be individually stored so that no child's bedding comes into contact with other 6 bedding . 7 1 I will send a copy of my POC to CCL by 5/4/2011 2 3 4 5 1 2 3 4 5 1 I will send a copy of POC to CCL by 5/4/2011 2 3 4 5 No lid on garbage can containing food waste. LPA's observed emptied yogurt containers and bread in the trash can in kitchen . The tras h can does not have a lid . 6 7 6 6 7 7 Failure to correct the cited deficiency(ies) , on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME : Linda Walker TELEPHONE : (707) 588-5034 LICENSING EVALUATOR NAME: S usan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: Pn!ib~?-~YI~/)~ DATE: 04/21/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE : 04~~ LIC809 (FAS) • (0 6/04) DATE: 04/21/2011 Page : 3 of 3 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visiVinvestigation of a complaint received in our office on 10/07/2010 and conducted by Evaluator Terri Jensen COMPLAINT CONTROL NUMBER: 01-CC-20101007154508 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 17 UNANNOUNCED MET WITH: Ray Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 10/14/2010 09:30AM 12:30 PM ALLEGATION(S): 1 Child on child, inappropriate behavior 2 Children do not have adequate supervision 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Complaint Specialist Terri Jensen and LPA Jude Burden conducted an unannounced facility visit for the 2 purpose of meeting the ten day requirement to notify the licensee of a new complaint. 3 Both the director and assistant director were interviewed privately during this visit, as well as one 4 preschool teacher. Files for children named in the incident were reviewed. Facility Roster obtained. 5 Further investigation is needed. 6 7 NOTICE OF SITE VISIT POSTED 8 9 10 11 12 13 Estimated Days of Completion: 90 days Needs Further Investigation SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Terri TELEPHONE: (707) 588-5026 Je~ s ~ TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE: ~~ DATE: 10114/2010 I acknowledge receipt of this fonn and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10114/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC9099 (FAS)- (08104) Pege: 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 101 GOLF COURSE DR . STE. A·230 ROHN ERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 10/07/2010 and conducted by Evaluator Terri Jensen COMPLAINT CONTROL NUMBER: 01-CC-20101007154508 PUBLIC FACILITY NAME : CHI LDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR :WELCH , MARY ADDRESS : 1078 EAST AVENUE CITY: NAPA STATE : CAPACITY: 64 CENSUS : 24 UNANNOUNCED Ray Welch MET WITH: FACILITY NUMBER: FACILITY TYPE : TELEPHONE : ZIP CODE: DATE: TIME VISIT BEGAN : TIME COMPLETED : 283005477 850 (707) 224-3825 94559 01/03/2011 01 :00PM 02:55PM ALLEGATION(S): 1 Child on Chi ld Inappropriate behavior 2 Children do not have adequate supervision 3 4 5 6 7 8 9 INVESTIGATION FINDINGS : 1 Complaint Specialist- Terri Jensen and LPA Barbara Lawler, conducted an unannounced facility visit for 2 the purpose of delivering final findings for the above stated allegations. 3 This investigation consisted of personal interviews with director and staff of Children Cottage, persona l 4 and telephone interviews with parents of children currently and formerly enrolled for care at the center, 5 personal interviews with children currently and formerly enrolled at the center, review of ch ildren's files, review 6 of Napa County Child Welfare Services Report and phone call with Napa County Social Worker,review of Napa 7 County CPS report, phone call with detective from Napa Sheriff's Department and verbal review of the report 8 prepared by the detective. 9 Investigation findings reveal that children were involved in inappropriate touching of one another, on 10 more than one occasion , without the knowledge of staff. Child ren disclosed to staff that they were playing a 11 game referred to as the "naked game", however staff did not observe this game, nor did they follow up with 12 children to pursue the details of the game, or inform parents of the disclosure. Children interviewed report that 13 staff were sitting on a bench/table during the times that the "naked game" was being played. Substantiated Estimated Days of Completion : SUPERVISOR'S NAME: Linda Walker TELEPHONE : (707) 588-5026 LICENSING EVALUATOR NAME : Terri J~JA LICENSING EVALUATOR SIGNATURE :(/ • V u ~ A o ~,..., l/V v.t,_.,(/ TELEPHONE: (707) 494-8334 y """" DATE : 01/03/2011 I acknowledge receipt of this fo rm and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE : 1/-<( CVJ vV~~ DATE : 01/03/2011 Control Number 01-CC-20101007154508 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE : 01 /03/2011 NARRATIVE 1 2 These allegations are substantiated . See LIC 9099D for citations issued during th is visit. 3 4 5 6 7 NOTICE OF SITE VISIT POSTED APPEAL RIGHTS AND NEVER SHAKE A BABY BROCHURE GIVEN Upon receipt , licensee shall post for 30 days and provide copies of this licensing report to parents/guardians of ch ildren 1n ca re at the facility w1th1n the next 24 hours or the next time the ch1ld is in care, and to parents/ guard1ans of children newly enrolled at the facil1ty during the next 12 months. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME : Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Terri Jense TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE: t~~ DATE: 01/03/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE : DATE: 01 /03/2011 LIC9099 (FAS) • (06/04) Page : 3 of 3 Control Number 01-CC-20101007154508 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regio nal Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number Type A 01/04/2011 Secti on Cited 101229(a)(1) DEFICIENCIES 1 2 3 4 5 PLAN OF CORRECTIONS(POCs) CARE AND SUPERVISION: No Child(ren) shall be left without the supervision, including visual observation , of a teacher at any time. Investigation findings reveal that children in care were involved in inappropriate touching of one another without the knowledge or visual observation of a teacher. This is an immediate 6 7 1 2 3 4 5 8 9 9 10 11 12 13 14 10 11 12 13 14 1 2 3 4 5 6 7 Children will be visually supervised at all times. Training on supervision and children's rights will be provided to the lead teacher who will immediately alert all staff. A detailed training will be provided to staff on 1-7-11. I will sumit a written summary of the training along with a list of all staff in attendance . 6 7 8 ask to the health and safety of children in care. Type A 01/04/2011 Section Cited 101223(a)(2) FACILITY NUMBER: 28 3005477 VISIT DATE : 01/03/20 11 PERSONAL RIGHTS: Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Investigation findings reveal that a child in care received injury to his rectum as a result of another child putting a stick in his bottom during hours of operation . This is an immediate risk 8 to the health and safety of children in care. 1 See above. 2 3 4 5 6 7 8 9 9 10 11 12 13 14 10 11 12 13 14 Fai lure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME : Linda Walker LICENSING EVALUATOR NAME : Terri Je~~ LICENSING EVALUATOR SIGNATURE :.. • "..1 0 . ~t1A~ 11 TELEPHONE: (707) 588-5026 TELEPHONE : (707) 494-8334 DATE : 01/03/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE : 01/03/2011 This Notice must be posted for 30 days ucsoss (ms) - (06104) Page? 2 ?f 3 STATE OF CALIFORNIA· HEA LTH AN D HUMAN SERVICES AGE NCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMU NITY CARE LICENSI NG DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regio nal Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE : 01/03/2011 FACILITY NAME: C HILDREN'S COTIAG E - PRESC HOO L DEFICIENCY INFORMATION FOR THIS PAGE : Defici ency Type POC Due Date I Section Number Type A 01 /04/2011 Section Ci ted 101226.3 Type A 01 /04/2011 Section Cited 101229 (a)(1) Type A 01 /04/2011 Section Cited 101229(a) PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 OBSERVATION OF THE CHILD: Any unusual behavior of a ch ild shall be reported to the child's authorized representative . A child disclosed to a teacher that another child wanted to play the naked game. The teacher fai led to investigated this disclosure. She further did not report the disclosure 7 to the parents of the 1 2 3 4 5 6 8 children involved . As a child rece ived an injury as 9 a result of this game, this is an immediate risk to 10 the health and safety of children in care. 11 12 13 14 8 the week. I will submit a summary of this training 9 along with a list of all staff in attendance . 10 11 12 13 14 CARE AND SUPERVISION: No child(ren) shall be left without the supervision , including visual observation , of a teacher at any time. Children are allowed to go to the bathroom without visual supervision of a teacher. If a child discloses an unusual statement to a teacher, the teacher will follow up by questioning the child and report to the director and parents if appropriate , especially if an injury is involved . Training will be provided to the lead teacher today, who will verbally alert all staff. Formal training will 7 be conducted by the end of 7 Children will be visually supervised when going to the bathroom by a tea cher or an aide and the office will be called if necessary. Training will be provided to the lead teacher today, who will verbally alert all staff. Formal training will be conducted by the end of the week . I will submit a summary of this 7 training along with a list of all staff in attendance. 1 2 3 4 5 6 1 See above . 2 3 4 5 6 1 2 3 4 5 6 CARE AND SUPERVISION:Licensee shal l provide care and supervision to meet the child's need . The needs of children are not always met in terms of assistance in the bathroom Staff do not ensure that chil dre n are cleaned after bathroom use . this is an immediate risk to the health and safety of 7 children in care . 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies) , on o r before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Wal ker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Terri Jensen TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE : DATE : 01/03/2011 I ac k nowledge rece i pt of this form and understand my appeal rights as explained and received. w FACILITY REPRESENTATIVE SIGNATURE : (;/J;ry DATE : 01 /03/2011 This Notice must be posted for 30 days LIC809 (FAS) • (06/04) Page: 3 of 4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Reg ional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE : 01/03/2011 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 01/07/2011 Section Cited 101206(1 )(c) DEFICIENCIES 1 2 3 4 5 6 7 REVOCATION OR SUSPENSION OF A LICENSE: The Department may suspend or revoke any license, under this act upon the following grounds: Conduct which is inimical to the health, morals, welfare , or safety of either an individual in or receiving services from the facility or the people of this state . It has been determined that PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 8 the signature on an LIC 9224, as required by 9 AB633 , is not the signature of the parent of the 10 child , for whom the report indicates. 11 12 13 14 8 9 10 11 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Prior to making a plan of correction , I would like to examine the signatures in question. I do not understand how this happened . CS Jensen will FAX or scan 226-8118 copies of LIC 9224. ray@children 's cottage .com Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Terri Je nsen TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE: ~rr~ DATE: 01/03/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2011 This Notice must be posted for 30 days LIC809 (FAS) • (06/04) Page: 2 of 4 STATE OF CALIFORNIA· HEAL TH AND HUMAN SERVI CES AGENCY CALIFORN IA DEPARTMENT OF SOCIAL SERVICES COMMUN ITY CARE LICENSING DIVIS ION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE . A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE- PRESCHOOL FACILITY ADDRESS 01/03/2011 CITY 1078 EAST AVEN UE STATE NAPA ZIP CODE CA LICENSEE(S)/OPERATO R 94559 FAC ILITY NUMBER CHILDREN'S COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per Ca liforn ia Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed . The above faci lity has been found in violation of the Cal ifornia Code of Reg ulations , Titl e 22 , Divisions 6, and/or 12, Section(s) 101226.3 and/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4, and 3.5 Section(s) A Facility Eva luation Report (LIC 809) was issued on 10/14/2010 giving notice that fa ilure to co rrect the above violation(s) would result in a civil penalty. ~ x ~x Because you failed to make the corrections specified on the LIC 809 , a civil penalty of $0.00 is assessed for the pe riod from th rough . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed. This wi ll continue until correction(s) are made to co mply with the licensing laws , regulations , and approval of the Cal iforn ia Department of Social Services or authorized licensing agency. Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for , the day the deficiency was cited . x All Facility Types : Second citation within a 12 month period ; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. 'l x - 0 0 x x Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period; an immediate civi l pe nalty of $1,000 per violation th en $100 per day per violation until corrections are made . Fami ly Child Care Homes (FCCH), Child Care Centers (CCC), Comm unity Ca re Facility (CCF) : Third citation within 12 month period ; an immediate civil penalty of $150 per violation then $150 per day per violation unti l corrections are made. Violations which result in injury, sickness , or death An immediate civil penalty of $150 per vioation and then $150 pe r day pe r violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENS ING PROGRAM ANALYST Terri Jensen SIGNATURE OF LI CE NSING PROGRAM ANALYST ~A')t}vU KCfi:~ NAME OF FACILITY REPRE SENTATIVE/TITLE SIGNATURE OF FACILITY REPRE SENTATIVE --1\~ w~ SUPERVISOR REVI EW SIGNATURE (FOR INTERNAL USE ONLY) DATE 01/03/ 2011 TITL E LIC421 (FAS) • (05/06) Page : 1 ol 2 STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 DATE FACILITY NAME CHILDREN'S COTTAGE- PRESCHOOL 01 /03/2011 CITY FACILITY ADDRESS 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTIAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil pena lties can be assessed against any faci lity which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99 . You are hereby notified that a civil penalty has been assessed . The above facility has been found in vio lation of the Cal ifornia Code of Regulations , Title 22 , Divisions 6, and/or 12, Section(s) 101229(a)(1 land/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4 , and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 10/04/2010 giving notice that failure to correct the above vio lation(s) would result in a civi l penalty. ~ L.....J Because you failed to make the corrections specified on the LIC 809 , a civil pena lty of $0.00 is assessed for the from through . 0 x A civil pena lty of $50 per violation per day, up to a maximum of $150 per day will be assessed . This wi ll continue until correction(s) are made to comply with the licensing laws , regulations , and approval of the Ca lifornia Department of Social Servi ces or authorized lice nsing ag ency. x period ~x 0 x Because you repeated a violation of the same su bsection within a 12 month period ,an immediate civil penalty of $1 50 .00 is assessed for , th e day th e defi ciency was cited. ~ x All Facility Types: Second citation within a 12 month peri od; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made . 0 x Residential 0 x Fam ily Care Facility for the Elderly (RCFE) , Res idential Care Facility for the Chronica lly ILL (RCF-CI): Third citation within 12 month period ; an immediate civil penalty of $1 ,000 per violatio n then $100 per day per violation until corrections are made. Chi ld Care Homes (FCCH), Child Ca re Centers (CCC) , Community Care Facility (CCF) : Third citation with in 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. Violations which result in injury, sickness , or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made . YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Terri Jensen SIGNATURE OF LI CENSING PROGRAM ANALYST ~~~~ NAME OF FACI LITY RE PRESENTATIVEfTITLE SIGNATURE OF FACILITY REPRESENTATIVE ~ -v\0v; { VVA;h / SU PERVISOR REVIEW SIGNATURE (FOR INTERNAL US E ON LY) DATE 01 / 03/ 20 11 TITLE LIC421 (FAS) • (05/06) Page: 1 of 2 / STAT E OF CALIFORNIA · HEALTH AND HUMAN SERVI CES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSI NG DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME DATE CHILDREN'S COTTAGE - PRESCHOOL FACILITY ADDRESS 01/03/20 11 CITY 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties ca n be assessed agai nst any faci lity which fai ls to take correcti ve action within prescribed time pe riods, per California Health and Safety Code Sections 1548, 1568.0822 , 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed . The above facility has been found in vio lation of the Cal ifornia Code of Reg ulations, Title 22 , Divisions 6, and/or 12, Section(s) 101223(a)(2) and/or Californ ia Health and Safety Code , Chapters 3, 3.01 , 3.2 , 3.4 , and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 10/04/2010 giving notice that failure to correct the above violatio n(s) wo uld resu lt in a civil penalty. x ~x Because you failed to make the corrections specified on the LIC 809, a civil penalty of $0.00 is assessed for the period from through . 0 x A civil penalty of $50 per violation per day, up to a maxi mum of $150 per day wil l be assessed. This will co ntinu e unti l co rrection (s) are made to comply with the lice nsing laws, regu lations, and approval of the Californi a Department of Social Services or authorized licensi ng agency. Beca use you repeated a violation of the sam e subsectio n within a 12 month pe riod ,an imm ediate civi l penalty of $150.00 is assessed for , the day the defi ciency was cited. ::J x All Facility Types: Second citation within a 12 month period ; an immed iate civil pe nalty of $150 per violatio n then $50 per day per violation until corrections are made. n X - Res identia l Care Facil ity for the Elderly (RCFE) , Resid ential Care Facility fo r the Chronically ILL (RCF-CI): Third citation within 12 month period; an im mediate civil pe nalty of $1 ,000 per violation th en $100 per day per viola tion until corrections are made. = x 0 Fa mily Child Ca re Homes (FCCH) , Child Care Centers (CCC) , Commu nity Care Facility (CCF) : Third citation within 12 month period ; an immediate civil pe nalty of $150 per vio lation then $150 per day per violation until co rrections are mad e. x Violatio ns which result in injury, sickness , or death An immediate civi l penalty of $150 per vioatio n and th en $150 per day per violation until co rrectio ns are made . YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICEN SING PROG RAM ANALYST Terri Jensen SIGNATURE OF LIC ENSING PROGRAM ANALYST ~r~ NAME OF FACI LITY REP RES ENTATIVE/TITLE SI GNATURE OF FACILITY REPRESE NTATIVE rXct1 ~~ SUPERVI SOR REVIEW SIGNATURE (FO R INTERNAL USE ONLY) DATE 01 /03/2011 TITLE LIC421 (FAS) • (05/061 Page : 1 of 2 STATE OF CALIFORNIA· HEALT H AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: WE LCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CA CAPACITY: 64 CENSUS: 24 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH : Ra y Welch 1 2 FACILITY NUMBER: FACILITY TYPE: TELEPHONE : ZIP CODE : DATE : TIME BEGAN: TIME COMPLETED : 283005477 850 (707) 224-3825 94559 01 /03/2011 01 :00PM 02:50PM NARRATIVE Complaint Specialist Terri Jensen and LPA Barbara Lawler, co nducted an unannounced facility visit fo r the purpose of case management. See LIC 809 D for citations issued during this visit. 3 4 5 6 7 NOTICE OF SITE VISIT POSTED APPEAL RIGHTS AND NEVER SHAKE A BABY BROCHURE GIVEN Upon receipt, licensee shall post for 30 days and provide copies of this licensing report to parents/guardians of chi ldren in ca re at the facility within the next 24 hours or the next time the child is in care, and to parents/ guardians of children newly enrolled at the facility during the next 12 months. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Terri u J~/J ;1 LICENSING EVALUATOR SIGNATURE'' A VwvJcntw~ TELEPHONE: (707) 588-5026 1 "' ~ TELEPHONE: (707) 494-8334 VVV"--t/ V '-DATE: 01/03/20 11 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE : -VB;hiJJ~ DATE: 01 /03/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years . LIC809 (FAS) • (06/04) Pag e: 1 of 4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORN IA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME : CH ILDREN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE : 0 1/03/2011 DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number Type B 01/07/2011 Section Cited HS1596.857(B) Type 8 01 /07/2011 Section Cited HS 1596.8595(c) DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 HEALTH AND SAFETY: No child day care facility shall discriminate or retaliate against any child or parent or guardian on the basis or for the reason that the parent or guardian has exercised his or her right under this section to inspect the facility or has lodged a complaint with the department against a facility . The 8 9 10 11 12 13 14 licensee made a suspected child abuse report against a fam ily in care , after a child disclosed that another child touched him/her inappropriately at the day care center. The director reports he had good reason, yet there is no documentation to support this and no children were questioned about the incident. Also the director did not report to CPS . three other families , whose children were also involved in the inappropriate touching . 1 2 3 4 5 6 7 1 We will try moving the sign in sheet to the office on HEALTH AND SAFETY: The licensee failed to provide copies of licensing reports indicating Type 2 the days that we need signatures for Type A 3 violations The co-director will file the LIC 9224 on A violations and failed to maintain written 4 the same day. I will submit this new procedure for verification of receipt of Type A violations. Parent confirmed not receiving licensing reports and Type 5 sign in , in writing by 1-7-10. 6 A citations and further verified that the 7 signature on the LIC 9224 on file , is not his/hers. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 I disagree that this is retaliation. The child was definitely not himself after not being at school for 5 days and 3 staff met and consulted and honestly felt that there was something that needed to be investigated. 8 9 10 11 12 13 14 Failure to correct th e cited deficiency(ies) , on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME : Linda Walker TELEPHONE : (707) 588-5026 LICENSING EVALUATOR NAME: Terri Jen TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE : \/Ww~ DATE: 01/03/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE : ti!!?Vf LIC809 (FAS) • (06104) DATE : 01/03/2011 Page: 4 of 4 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR: WELCH , MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE:CA CAPACITY: 64 CENSUS: 17 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Ray Welch 1 2 3 4 5 6 7 8 9 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 10/14/2010 09:15AM 12:30 PM NARRATIVE Complaint Specialist Terri Jensen and LPA Jude Burden conducted an unannounced facility visit for the purpose of case management. LPAs met with Director, Ray Welch . An Unusual Incident Report for an alleged incident was received at the Rohnert Park Licensing office by fax, on 9-27-10. The licensee was made aware of the alleged incident on September 15, 2010. The licensee failed to notify the Department by the end of the next working day of the alleged incident or received a written report within 7 days. Files for the children named on the incident report were reviewed . There is no record of the incident recorded in either child's file . See LIC 809D for citations issued during this visit. 10 11 NOTICE OF SITE VISIT POSTED APPEAL RIGHTS GIVEN 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Linda Walker LICENSING EVALUATOR NAME: Te ~lem!en--tf-,.....,...:__ TELEPHONE: (707) 588-5026 TELEPHONE: (707) 494-8334 DATE: 10/14/2010 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: t3k!~ WM DATE: 10/14/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) - (06104) Page: 1 of2 .- STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE: 10/14/2010 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number PLAN OF CORRECTIONS(POCs) DEFICIENCIES TypeS 10/29/2010 Section Cited 101226.3 (b) 1 2 3 4 5 6 7 TypeS 10/29/2010 Section Cited 101212(a) 1 2 3 4 5 6 7 OBSERVATION OF THE CHILD: Any unusual behavior or injury shall be recorded in the child's files. A review of children's files reveal that there is no documentation of an unusual incident in the file of either child named in the incident report. 1 2 3 4 5 6 7 REPORTING REQUIREMENTS:Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written 1 I will read the regulation and train staff. I will 2 submit a written summary of my understanding of 3 this regulation, signed by all staff. 4 5 6 7 We have a separate file for this incident. I will read the regulation and train staff. I will submit a written summary of my understanding of this regulation, signed by all staff. 8 report containing the information specified in (d)(2) 8 9 10 11 12 13 14 below shall be submitted to the Department within seven days following the occurrence of such event. The center became aware of an unusual incident on Sept. 15th. The Department was not notified by the end of the next working day, nor was the incident report received in 7 days. 9 10 11 12 13 14 1 2 3 4 5 1 2 3 4 5 6 6 7 7 Failure to correct the cited deflciency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5026 LICENSING EVALUATOR NAME: Terri .w-rr-l:ffi:/ TELEPHONE: (707) 494-8334 LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2010 LIC809 (FAS)· (06104) Page: 2 of2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a compla int received in our office on 09/23/201 0 and conducted by Evaluator Susan Keehn PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20100923120046 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE : CENSUS : 26 CAPACITY: 64 UNANNOUNCED MET WITH: Yasmin Solaria , Director ALLEGATION(S): 1 Personal Rights : 2 Neglect/Lack of Supervision: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 10/04/2010 11 :20 AM 01:10PM Staff yell at child(ren) Children left unattended to cry for long periods of time 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA S. Keehn and J . Burden visited for the purpose of interviewing staff to conclude the investigation of the 2 above allegations. Ms. Solaria denies both allegations. She does say that within the last few weeks, there 3 was an infant who enrolled and had a hard time adjusting . This child cried for about 25 minutes until staff 4 called the parent. This is the only occasion she can recall where a child cried for more than a few minutes. 5 She denies knowledge of any staff member yelling at children. Four separate witnesses state that sometimes 6 many children at this center are crying or screaming and crying. It is reported that one or more are crying for 7 long periods of time. One witness reported that a girl was "crying her heart out" and this went on for 8 approximately 20 to 30 minutes. A staff person was heard to yell at this child in a harsh tone to stop crying . 9 Three separate witnesses report that they have heard staff yelling at chi ldren. The allegations are 10 substantiated . Present are 26 prechool children with 4 staff. 11 See 809D for deficiency. Appeal Rights given. Notice of site visit posted . Failure to keep this notice 12 posted for 30 days may result in a civil penalty of $100 . Upon receipt, licensee shall post and provide 13 Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Myrtle Herin-Wahlstrom TELEPHONE: (707) 588-5036 LICENSING EVALUATOR NAME: Susan Keehn TELEPHONE: (707) 588-5056 LICENSING EVALUATOR SIGNATURE: J DATE: 10/04/201 0 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~ DATE: 10/04/201 0 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) • (06/04) Page: 1 of 3 Control Number 01 -CC-20100923120046 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AG ENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regio nal Office, 101 GOLF COU RSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILD REN'S COTIAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE : 10/04/2010 NARRATIVE 1 2 3 4 copies of this licensing repo rt to parents/g uard ians of children in care at the faci lity and to parents/g uardians of children newly enro lled at the faci lity during the next 12 months. Fa ilure to complete plan of co rrection may result in a civil penalty. Licensing information and updates are available at www.ccld.ca.gov. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME : Myrtle Herin-Wahlstrom TELEPHONE: (707) 588-5036 LICENSING EVALUATOR NAME: Susan Kee hn TELEPHONE: (707) 588-5056 ; LICENSING EVALUATOR SIGNATURE : DATE: 10/04/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~ ~~~~~ LIC9099 (FAS) • (06/04) DATE : 10/04/2010 Page: 3 of 3 Control Number 01-CC-201 00923120046 STATE OF CALI FORNIA· HEALTH AND HUMAN SERVICES AG ENCY CALIFORNIA DEPARTMENT OF SOC IAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regiona l Office, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTIAGE- PRESCHOO L DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number Type A 10/05/2010 Section Cited 101223(a)(3) Type A 10/05/20 10 Section Cited 101229(a)(1) FACILITY NUMBER: 283005477 VISIT DATE : 10104/2010 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 Personal Rights . Each child shall be free from corporal or unusual punishment, humiliation, intimidation, ridicule , coercion. threat. mental abuse, or other actions of a punitive nature. Investigation findings reveal that witnesses have heard staff yell at children in care. In addi- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 tion, a ch ild in care was heard to be sobbing and crying in excess of 20 minutes and a staff member yelled at the child to stop crying. This is an immediate risk to the emotional well-being of chidlren in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 Care and Supervision . No child(ren) shall be left wi thout the supervision , including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1 ). Investigation reveals that children in care cry for up to 20 to 30 minutes. 1 2 3 4 5 6 8 9 10 11 12 13 14 Some children scream and cry. Witnesses 8 say that this has been going on for years. 9 Supervision necessary to meet the children's needs 10 is not being given as these children are left to cry. 11 This is an immediate threat to children's safety and 12 well-being . As this is a second violation within 12 13 months, civil penalty. 14 7 Staff do not yell at children . I will have an all staff meeting to advise staff of the allegations and go over the regulation . If I became aware of a staff member yelling at children, I would relieve the staff member and then give the staff person training . I am here all day and children are not left to cry. We comfort, redirect, take the child outside, switch staff to calm a chi ld down. I will have an all staff meeting to advise staff of the allegations and go over the regulation. 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Myrtle Herin-Wa hlstrom TELEPHONE: (707) 588-5036 LICENSING EVALUATOR NAME : Susa n Kee hn TELEPHONE : (707) 588-5056 LICENSING EVALUATOR SIGNATURE: xf~ DATE : 10/04/20 10 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: Ni~JPr\~ ~ DATE: 10/04/2010 This Notice must be posted for 30 days LIC9099 (FAS) • (06/04) Page: 2 of 3 / STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CIVIL PENALTY ASSESSMENT CCLD Regional Office, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 DATE FACILITY NAME CHILDREN'S COTTAGE- PRESCHOOL 10/04/2010 CITY FACILITY ADDRESS 1078 EAST AVENUE NAPA STATE ZIP CODE LICENSEE(S)/OPERATOR FACILITY NUMBER 94559 CHILDREN'S COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility wh ich fails to take corrective action within prescribed time periods , per Californ ia Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby notified that a civil penalty has been assessed . The above facility has been found in vio lation of the California Code of Regulations , Title 22 , Divisions 6, and/or 12, Section(s) 101229a and/or California Health and Safety Code , Chapters 3, 3.01 , 3.2, 3.4 , and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 11/17/2009 giving notice that failure to correct the above violation(s) would result in a civil penalty. _ ~ x Because you failed to make the corrections specified on the LIC 809 , a civil penalty of $0.00 is assessed for the period from through . 0 x A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed . This will continue until correction(s) are made to comply with the licensing laws , regulations , and approval of the California Department of Social Services or authorized licensing agency. x Because you repeated a violation of the same subsection within a 12 month period ,an immediate civil penalty of $150.00 is assessed for 10/04/2010, the day the deficiency was cited . x All Faci lity Types : Second citation within a 12 month period ; an immediate civil penalty of $150 per violation th en $50 per day per violation until corrections are made. 0 [J x Residential Care Facility for the Elderly (RCFE) , Residential Care Facility for the Chronically ILL (RCF-CI): Third citation within 12 month period ; an immediate civil penalty of $1 ,000 per violation then $100 per day per violation until corrections are made . 0 x Family Ch ild Care Homes (FCCH) , Child Care Centers (CCC) , Community Care Facility (CCF) : Third citation within 12 month period ; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. 0 x Violations which result in injury, sickness , or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR BILL! NAME OF LICENSING PROGRAM ANALYST Susan Keehn SIGNATURE OF LICENSING PROGRAM ANALYST NAME OF FACILITY REPRESENTATIVE!TITLE Yasmin Solaria SIGNATURE OF FACILITY REPRESENTATIVE SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL USE ONLY) DATE 10/04/ 201 0 TITLE LIC421 (FAS) • (05/06) Licensing Program Manager Page: 1 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL ADMINISTRATOR:WELCH , MARY ADDRESS: 1078 EAST AVENUE STATE: CA CITY: NAPA CENSUS: 34 64 CAPACITY: UNANNOUNCED TYPE OF VISIT: Annual/Required MET WITH: Ray Welch 1 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 05/18/2010 09:20AM 03 :30PM NARRATIVE THIS IS AN AMENDED REPORT AND SUPERCEDES FACILITY EVALUATION REPORT DATED 2 5/18/201 0. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LPA's Susan Keehn and Barbara Lawler made today's Required Annual visit and conducted a comprehensive inspection for compliance with Health, Safety and Title 22 regulations . Staff opening and closing have current EMSA pediatric CPR and First Aid . Licensee states both he and the infant director will be renewing pediatric CPR on May 22, 2010 . LPA's inspected all preschool classrooms and outdoor play areas of this combination infant and preschool age center. Services are provided year round 7AM-6PM Monday thru Friday for children ages birth thru entry of first grade. LPA's observed children under the care and supervision of staff during outdoor play , and indoor activities. Children and staff were observed on play yard and in classroom , Pre-K teacher was with ten children in her care during classroom activities . Pre K teacher was observed respectful and attentive with the children. Staff and child ratios were observed in compliance today. The following were reviewed , verified and inspected: Facility postings Site has working telephone Children's roster received today , dated May 2010. Children's and parent's sign in and out sheets Staff file reviewed. At least one teacher on site has current pediatric EMSA CPR and First Aid All children's bathrooms were inspected . Hot water does not exceed 120 degrees, hand soap , paper towels and toilet paper was available in most of the bathrooms. Heating, ventilation and lighting was observed adequate in classrooms and bathrooms Staff state diapering is performed on the floor with changing pad, next to cubbies containing children's diapers. Children have cubbies and hooks to store their personal belongings Children's equipment, furnishings, activities and toys are age and developmentally appropriate Snack menu posted, children were served mixed fruit and crackers during this morning 's snack 0. Lunches are provided by parents SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: CJ v~~;k ~· sf.~~ DATE: 05/18/2010 soC\P!;..,,....t>).. .. t\\\\\ o;.~\-~f~·· I acknowledge receipt of this form and understand my licensing appeal rights as explained 'ilnd rectij~'ld.\ ~ . ,,,., .... •~f.\~ --..~ ~· \..\C~ FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • (06/04) . ~_., ·'( cr-- Page: 1 of 5 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL FACILITY NUMBER: 283005477 VISIT DATE: 05/18/2010 NARRATIVE 1 Mats used for napping were observed stored properly 2 3 4 5 Outdoor play yard is fully fenced. Climbing structures and equipment are age and developmentally appropriate . Climbing structures have adequate amounts of sand surrounding and underneath . Shade and drinking water is available 6 7 8 9 10 11 12 13 14 15 16 SEE FOLLOWING LIC 809 D REPORTS FOR TYPE A AND TYPE B DEFICIENCIES CITED APPEAL RIGHTS , AB 633 AND LIC 9224 PARENT;S ACKNOWLEDGMENT OF RECEIPT OF TYPE A LICENSING REPORTS WAS DISCUSSED 17 18 19 20 21 NOTICE OF SITE VISIT AND TYPE A LICENSING REPORTS SHALL BE POSTED FOR 30 DAYS 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2010 DEPT. OF SOGIAL SERVICES ROHNERT PARK R~GIONAL OFFICE LIC809 (FAS) • (06/04) Page: ~ of 5 MAY 2 4 2010 COMMUNITY CARE UCENSING STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A·230 ROH NERT PARK, CA 94928 FACILITY NAME : CHILDREN'S COTIAGE - PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number Type B 05/31 /2010 Section Cited 101239 f 1 Type B 05/18/2010 Section Cited 101539 FACILITY NUMBER: 283005477 VISIT DATE: 05/18/2010 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 Pre k classroom observed with open trash 2 container containing solid waste (banana peels) 3 (1) containers used for storage of solid wastes shall 4 have a tightfitting cover that is kept on . 5 6 7 1 POC 2 PROOF OF CORRECTION W ILL BE SENT TO 3 LICNESIN G BY MAY 31 2010 4 5 6 7 1 CHILDREN'S bathroom was not supplied with tol iet 1 2 Toliet paper will be stocked today, daily and as 2 paper 3 needed all bathrooms will be monitored to ensure 3 4 4 all bathrooms are continuously stocked with toliet 5 paper, hand washing soap and paper towels 5 6 7 6 7 1 2 3 1 2 3 4 5 6 7 4 5 6 7 1 2 3 1 2 3 4 5 6 7 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME : Linda Walker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2010 LIC809 (FAS) • (06/04) DEPT. OF SOCIAL SERVi~e3st s ROHNERT PARK RfGIONAl OFFICE MAY 2 4. 2010 COMMUNITY CARE LICENSING STATE OF CALIFORNIA · HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMU NITY CAR E LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) REDWOOD EMPIRE CC, 101 GOLF COURSE DR. STE. A-230 ROHNERT PARK, CA 94928 FACILITY NUMBER: 283005477 VISIT DATE : 05/18/2010 FACILITY NAME: CHILDREN'S COTIAGE- PRESCHOOL DEFICIENCY INFORMATION FOR T HIS PAGE : Deficiency Type POC Due Date I Section Number Type A Type A 05/11/2010 Section Cited 101238.2 d 2 05/20/2010 Type A 05/18/2010 Section Cited 101238 g PLAN OF CORRECTIONS(POCs) DEFICIENCI ES 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Preschool outdoor play yard observed with rebar steel rod protruding away from the wood border of sand area, CREATING AN IMMEDIATE TRIPPING HAZARD POC PROOF OF CORRECTION WILL BE SENT TO LICENSING 5/192010 UNTIL CORRECTED CHILDREN WILL NOT BE ALLOWED IN TH IS AREA, OR AREA OF HAZARD WILL BE COVERED.Staff will receive training on the above and proof of correction to licensing by May 19th 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Storage cabinet containing cleaning compound located next to children's bathroom was observed unsecured , child proof lock was on the cabinet door knobs but observed hanging on the knobs which allowed the 'Simple Green" cleaning compound accessible to children in care . Cabinet lock will be replaced and secured today so that contents inside are inaccessible to children . Staff will monitor the cabinet lock daily and as needed to ensure the cabinet is locked. Staff will receive training on the above. Proof of correction will be sent to licensing by May 19 2010. 7 lock secured during Ieday's visit 3pm 1 2 3 4 5 6 Failure to correct the cited deficiency(ies), on or bef ore the Plan of Correction (POC) due date, may resul t in a civil penalty assessment. SUPERVISOR'S NAME: Linda Walker TELEPHONE : (707) 588-5055 LICENSING EVALUATOR NAME: Barbara Lawler TELEPHONE : (707) 494-2125 LICENSING EVALUATOR SIGNATURE : DATE: 05/18/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received . FACILITY REPRESENTATIVE SIGNATURE : ~~ This Notice must be post ed for 30 days DATE: ~'W~fPSOCIAL SERVICES ROHNERT PARK REGIONAL OFFICE MAY 2 4 2010 COMMUNITY CARE liCENstNG CALIFORNIA DEPARTMENT OF SOCI AL SERVICES COMMUNITY CARE LICENSING DIVISION REDWOOD EMPIRE CC , 101 GOLF COURSE DR. STE. A·230 ROHNERT PARK, CA 94928 STATE OF CALI FO RNIA · HEALTH AND HUMA N SERVICES AGENCY FACILITY EVALUATION REPORT (Cont) FACILITY NAME : CHILDREN'S COTIAGE- PRESCH O O L FACILITY NUMBER: 283005477 VISIT DATE : 05/18/2010 DEFICIENCY INFORMATION FOR THIS PAGE : Deficiency Type POC Due Date I Section Number DEFICIENCIES Type B 05/31 /2010 Section Cited 101238a 1 Microwave ovens used in classrooms (PRE K) 2 observed dirty with dried on foods including cooked 3 corn 4 5 6 7 1 POC 2 proof of correction will be mailed to licensing by 3 May 31 4 5 6 7 Type B 05/31 /2010 Section Cited 101174 1 2 3 4 5 6 7 1 POC 2 proof of correction will be mailed to licensing by 3 May 31 4 5 6 7 Type B 05/31 /2010 Section Cited 101238 a 1 Preschool outdoor drinking fountain "oak barrel" 2 contained standing water 3 4 5 6 7 1 POC 2 proof of correction will be mailed to licensing by 3 May 31 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 REQUIRED POSTING Emergency Disaster Plan shall provide current staff assigned . Posting in Pre-K classroom contained only the names of Ray and Mary Welch , Mary is no longer working at this site PLAN OF CORRECTIONS(POCs) Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Linda Wa lker TELEPHONE: (707) 588-5055 LICENSING EVALUATOR NAME: Ba rbara Lawler TELEPHONE: (707) 494-2125 LICENSING EVALUATOR SIGNATURE : DATE: 05/18/20 10 I acknowledge receipt of this form and understand my appeal rights as explai ned and rece ived. FACILITY REPRESENTATIVE SIGNATURE : DATE : 05/18/2010 ~ ~?~ ~~ ~ ------------LIC 809 (FAS) • (06/04) DEPT. OF SOCIAl SERVICR e· 5 ot 5 ROHNERT ll•AK REGIONAL OFF~ . MAY 2 4 2010 COMMUNITY CARE LICENSING STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLO Regional Office, 101 GOLF COURSE OR STE. A-230 ROHNERT PARK, CA 94928 This is an official report of an unannounced visit/investigation of a complaint received in our office on 11/19/2009 and conducted by Evaluator Terri Jensen PUBLIC COMPLAINT CONTROL NUMBER: 01-CC-20091119163702 FACILITY NAME: CHILDREN'S COTTAGE- PRESCHOOL ADMINISTRATOR:WELCH, MARY ADDRESS: 1078 EAST AVENUE CITY: NAPA STATE: CAPACITY: 64 CENSUS: 25 UNANNOUNCED MET WITH: Ray Welch FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 283005477 850 (707) 224-3825 94559 02/24/2010 03:00PM 03:50PM ALLEGATION(S): 1 RETALIATION : The licensee retaliated against an employee for disclosing information regarding non 2 compliance to licensing. 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Complaint Specialist - LPA Terri Jensen and LPA Mary Klassen, conducted an unannounced facility 2 visit for the purpose of delivering final findings for the above stated allegation. 3 This investigation included two visits to the center in which the licensee denied LPAs the opportunity to 4 interview staff unless it was on the employee's own time; one brief personal interview with a teacher which took 5 place during the teacher's break; review of field notes from visit on 11-17-09, telephone interview with teacher 6 and two telephone interviews with witness. 7 Investigation findings reveal that on November 17, 2009, upon delivering citations at an exit interview, 8 licensee, Ray Welch , stated to CS Terri Jensen, that someone is going to get fired over this. Two days later on 9 November 19, 2009 the Department became aware that the licensee and co-director confronted an employee 10 about what was disclosed to licensing during the course of a private interview conducted by CS Jensen. The 11 employee was laid off by phone on November 19, 2009. This allegation is substantiated. 12 See LIC 9099D for deficiency cited during this visit. 13 NOTICE OF SITE VISIT POSTED Substantiated Estimated Days of Completion: TELEPHONE: (707) 588-5026 TELEPHONE: (707) 494-8334 DATE: 02/24/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06104) Page: 1 of2 · J Control Number 01-CC-20091119163702 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 101 GOLF COURSE DR STE. A-230 ROHNERT PARK, CA 94928 FACILITY NAME: CHILDREN'S COTTAGE - PRESCHOOL DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 03/03/2010 Section Cited H & S 1539 FACILITY NUMBER: 283005477 VISIT DATE: 02/24/2010 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 HEALTH AND SAFETY CODE: Investigation findings reveal that the licensee retaliated against an employee as a result of the employee disclosing information regarding non compliance of the center to licensing staff. 6 7 I don't remember saying , someone is going to get fired over this. An employee was let go on November 19,09 due to low enrollment. She was rehired as a sub around Jan. 25, 2010. A month later another employee was let go also due to low enrollment. I disagree there was a retaliation . 6 However, I will review the policy regarding 7 retaliation and submit a summary of my understanding in writing to licensing 3-3-10. 1 2 3 4 5 1 2 3 4 5 1 2 3 4 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 5 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment TELEPHONE: (707) 588-5026 TELEPHONE: (707) 494-8334 DATE: 02/24/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: t5<:_v; DATE: 02/24/2010 I I. (X) (74 SIAYE OF CALIFORNIA HEALTH AND HUMAN SERVICES CALIFORNIA DEPARTMENT OF SOCIAL sggvicgs NOTICE OF CIVIL PENALTIES DUE Initial Invoice Final Notice INVOICE NO. 0101514 DISTRICT OFFICE NUMBER 01 NAME YEAR I I I Children's Cottage?Preschoo I 10/11 1/11/11 FACILITY ADDRESS FACILITY TYPE PENALTY PCA CODE 1073 East Ave 34035 I ZIP CODE Napa CA 94559 UINILICEHNSEDIFACILIZIY OPEHAIOR I '1 I 11 A Children's Cottage Child Care Inc. 283004489 i 3382 Court lcirv I I STAIE I I I ZIP CODE Napa CA 94558 The California Health and Safety Code, Sections 1548, 1568.0822, 1569.49, 1596.99, and 1597.62 provides for the imposition of civil penalties against any facility which falls to take corrective action within prescribed time periods. The California Health and Safety Code, Sections 1547, 1568.0821, 1569.485, 1596.89, 1596.891 and 1597.61 provides for the imposition of civil penalties against any unlicensed facility which fails to take corrective action within prescribed time periods. Your facility has been found in violation of Community Care Licensing statutes and regulations. Failure to correct the deficiency(ies) cited on the Licensing Report (LIC 809, 9099) dated 1/3/11 has resulted in the following civil penalty assessment of: Penalty Amount Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15000 Less Payment(s) Received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 150-00 Send the enclosed copy of this notice and your payment to the address shown below within 10 days. Make checks payable to the California Department of Social Services. Please write your invoice and facility number on your check. COMMUNITY CARE LICENSING 101 GOLF COURSE DR., STE A-230 ROHNERT PARK, CA 94928 KIM NAGY 707-588-5026 FAILURE TO PAY MAY RESULT IN ANY OR ALL OF THE FOLLOWING: SMALL CLAIMS COURT ACTION, DENIAL, SUSPENSION OR REVOCATION OF A OR A FRANCHISE TAX BOARD INTERCEPT. LIC 422 (11:00) LIL l?5l?1 snare or CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PE ALTY ASSESSM NT CCLD Regional Office, 101 GOLF counse DR. sre. A-230 ROHNERT PARK, CA 94923 FACILITY NAME one COTTAGE - PRESCHOOL 01/03/2011 FACILITY ADDRESS cm: 1078 EAST AVENUE NAPA sure ZIP cone CA 94559 uc FACILITY NUMBER COTTAGE CHILD CARE INC. 283005477 LICENSED FACILITY Civil penalties can be assessed against any facility which fails to take corrective action within prescribed time periods, per California Health and Safety Code Sections 1548, 1568.0822, 1569.49, and 1569.99. You are hereby noti?ed that a civil penalty has been assessed. The above facility has been found in violation of the California Code of Regulations, Title 22, Divisions 6, and/or 12, Section(s) 101226.3 and/or California Health and Safety Code, Chapters 3, 3.01, 3.2, 3.4, and 3.5 Section(s) A Facility Evaluation Report (LIC 809) was issued on 10/14/2010 giving notice that failure to correct the above violation(s) would result in a civil penalty. Because you failed to make the corrections speci?ed on the LIC 809, a civil penalty of ?0.00 is assessed for the period from through . A civil penalty of $50 per violation per day, up to a maximum of $150 per day will be assessed. This will continue until correction(s) are made to comply with the licensing laws, regulations, and approval of the California Department of Social Services or authorized licensing agency. Because you repeated a violation of the same subsection within a 12 month period,an immediate civil penalty of ?150.00 is assessed for the day the de?ciency was cited. All Facility Types: Second citation within a 12 month period; an immediate civil penalty of $150 per violation then $50 per day per violation until corrections are made. Residential Care Facility for the Elderly (RCFE), Residential Care Facility for the Chronically ILL Third citation within 12 month period; an immediate civil penalty of $1,000 per violation then $100 per day per violation until corrections are made. Family Child Care Homes (FCCH), Child Care Centers Community Care Facility (CCF): Third citation within 12 month period; an immediate civil penalty of $150 per violation then $150 per day per violation until corrections are made. Violations which result in injury, sickness, or death An immediate civil penalty of $150 per vioation and then $150 per day per violation until corrections are made. YOU WILL RECEIVE A BILL IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR NAME OF LICENSING PROGRAM ANALYST Terri Jensen SIGNATURE OF LICENSING PROGRAM ANALYST itzww NAME OF FACILITY SIGNATURE OF FACILITY REPRESENTATIVE aw/wax SUPERVISOR REVIEW SIGNATURE (FOR INTERNAL use ONLY) DATE QM-Blzmi I I Lic-I21 Page: 1 or 2 Children?s Cottage Child Care, Inc. 1078 East Avenue; Napa. CA 94559 (707) 224-3825 Early Care Education since 1993 Voted Best Child Care in Napa Valley 6 weeks to 6 years State license #283005477 (Preschool) Federal Tax ID 68?0406691 May 25, 2010 Community Care Licensing 101 Golf Course Dr. Ste A-230 Rohnert Park, CA 94928 Plan of Corrections for Type violations for Facility 283005477 given on 5/18/2010 101238a Dirty microwave cleaned (see photograph) 101238a Oak barrel drinking fountain. Standing water replaced by draining rocks (see photograph) 101239f1 Open lid trash container replaced with closed lid trash container (see photograph) 101174 Mary Welch?s name removed from posted Emergency Disaster Plan (see copy) SERVICES OFFICE MAY 27 mm CARE IJCENSING